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Point Prevalence Surveys and Customized Interventions Are Good Strategies to Improve Antimicrobial Use: The Brazilian Experience

Published online by Cambridge University Press:  02 November 2020

Ana Paula Matos Porto
University of São Paulo
Icaro Boszczowski
Hospital das Clíicas University of Sao Paulo
Ines Pauwels
Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
Hospital das Clínicas – FMUSP
Evelyne Girão
Hospital Universitario Walter Cantídio and Hospital Regional Unimed Fortaleza, Ceará, Brazil
Patricia Esteves
Hospital da Luz, São Brazil Cristhieni Rodrigues, Hospital Alvorada, São Paulo, Brazil
Claudia Carrilho
Hospital Universitário Universidade Estadual de Londrina, Londrina, Paraná Brazil
Tiago Luiz Ferraz
Real Hospital Portugês de Beneficência em Pernambuco, Recife, Brazil Jaqueline Capobianco, Hospital Universitário, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
Camila Donini
Hospital da Luz, São Paulo, Brazil Rosane Coutinho, Hospital Alvorada, São Paulo, Brazil
Herman Goossens
Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
Silvia Figueiredo
São Paulo University
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Background: Although antimicrobial stewardship is recommended by Brazilian government, data regarding prescription practices in the country are scarce. Objective: To describe the impact of 2 point-prevalence surveys and customized interventions on antimicrobial consumption among 8 hospitals in 3 regions of Brazil. Method: In 2017 and 2018, 8 tertiary-care Brazilian hospitals conducted the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS). All enrolled hospitals were provided the 2017 results. The group discussed intervention strategies by WhatsApp and e-mail. Hospitals customized interventions, including feedback to prescribers, discussion with pharmacists, and antimicrobial use data in accreditation process. A web-based program was used for data entry, validation, and reporting of details on AMC prescriptions. The Global-PPS was developed by the University of Antwerp and was funded by bioMérieux. The 1-day prevalences in 2017 and 2018 are presented as risk ratios. The main outcomes are whole antimicrobial use in hospitals and intensive care units (ICUs). Prevalence of infections caused by multidrug-resistant organisms (MDROs) were reported. Results: Overall, 1,716 patients were evaluated, of whom 420 (52.5%) and 429 (46.8%) were using antimicrobials in 2017 and 2018, respectively (P = .02). In 33 ICUs, 170 patients (61.4%) and 204 patients (56.8%) were on antimicrobials, in 2017 and 2018, respectively (P = .20). Significant decreases of overall use were observed for vancomycin (from 11% to 7%; P =.01), meropenem (from 12% to 9%; P = .04), and linezolid (from 1.5% to 0.33%; P =.01). There was no significant increase in any singular drug or class of drugs. Within ICUs, vancomycin use decreased significantly (from 19% to 11%; P = .005), linezolid use decreased significantly (from 2.9% to 0.3%; P = .01), colistin use decreased significantly (from 4.3% to 1.7%; P = .05), and metronidazole use decreased significantly (from 6.5% to 2.8%; P = .03). We observed a nonsignificant decrease of infections caused by MDROs across the whole hospital (from 8.7% to 6.6%; P = .10) and in the ICUs (from 15.2% to 12.3%; P = .30). The most frequent infectious diagnoses were pneumonia (27%), intra-abdominal sepsis (14%), skin and soft-tissue infection (SSTI) (9.4%), urinary tract infection (9.1%), and sepsis and septic shock with no identified focus (SSNIF) (7.4%). There was a significant increase in SST (from 7.6% to 11.4%; P = .03) and a decrease in SSNIF (from 10.7% to 4.1%; P = .00002). In 2018, there were significantly fewer antimicrobial prescriptions for healthcare-acquired infections (from 52.6% to 43.6%; P = .0007) and more antimicrobial prescriptions for community-acquired infections (from 27.4% to 34.6%; P = .003). We detected no difference for medical or surgical prophylaxis. Conclusions: Feedback of prescription practices might have had an impact on local policies of antimicrobial use, as demonstrated by an overall decrease is antimicrobial use and a decrease in the ICU.

Funding: This study was supported by Biomérieux.

Disclosures: None

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