Introduction: Antimicrobial resistance (AMR) is a global public health issue, worsened by the indiscriminate use of antimicrobials in hospital settings. To address this challenge, the World Health Organization (WHO, 1998) and the Brazilian Health Regulatory Agency (Anvisa, 2017) have proposed guidelines for the implementation of Antimicrobial Stewardship Programs (ASPs), aiming to promote the rational use of these drugs. Objective: To evaluate the impact of implementing an ASP in the Emergency Department of the Hans Dieter Schmidt Regional Hospital (HRHDS), in Joinville, Brazil, on broad-spectrum antimicrobial prescription patterns and associated healthcare outcomes and costs. Data source: Secondary data were collected from electronic medical records and hospital administrative systems, covering the period from June to November 2023. Eligibility criteria: Included were patients admitted to the emergency department during the study period who received prescriptions for ASP-targeted antimicrobials. Exclusion criteria comprised prescriptions for topical antimicrobials, antifungals, antivirals, antiparasitics, and patients who died within 72 hours of admission. Participants and interventions: The sample comprised all patients prescribed Cefepime, Ertapenem, Imipenem, Meropenem, Piperacillin+Tazobactam, Teicoplanin, and Vancomycin. The intervention consisted of prescription review by an infectious disease specialist, with the possibility of drug substitution. Study assessment and synthesis methods: This was a retrospective, observational, cross-sectional study. Descriptive statistics and Pearson’s chi-square test were used to compare pre- and post-intervention periods. Results: A 7.36% reduction in hospital admissions (n=231) was observed. Total antimicrobial prescriptions decreased by 8.79% (739 to 674). Considering only ASP-targeted antimicrobials, there was a 36.87% reduction in effective prescriptions (179 to 113). Piperacillin+Tazobactam prescriptions significantly declined (p=0.003). No significant differences were found in the main hospital admission diagnoses. Limitations: This is a single-center, retrospective study with a non-probabilistic sample, which may limit the generalizability of the findings. Conclusion: The ASP implementation demonstrated a positive impact on the rationalization of broad-spectrum antimicrobial use, contributing to AMR containment. The strategy proved to be cost-effective, replicable, and aligned with national and international guidelines, supporting its expansion to other hospital sectors.
Santos et al. (Mon,) studied this question.
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