Multicenter Evaluation of Antibiotic Use and Antibiotic Stewardship Programs in Latin American Hospitals

Valeria Fabre; Sara E. Cosgrove; Yea Jen Hsu; Twisha S. Patel; Fernanda C. Lessa; Andrea Alvarado; Bowen Aquiles; Ana B. Arauz; Maria F. Barberis; Maria Del Carmen Bangher; Maria P. Bernachea; Marisa L. Bernan; Alfredo Canton; Ximena Castañeda; Angel M. Colque; Rosa Contreras; Wanda Cornistein; Silvia Mabel Correa; Gustavo Costilla Campero; Marta Isabel Chamorro Ayala; Lidia Espinola; Clara Esquivel; Cecilia Ezcurra; Johana Fernandez; Sandra Ferrari; Natalia Frassone; Carlos Garcia Cruz; Maria Isabel Garzón; Carlos H. Gomez Quintero; José A. Gonzalez; Lucrecia Guaymas; Fausto Guerrero-Toapanta; Sandra Lambert; Diego Laplume; Itzel L. Lopez; Herberth Maldonado; Noelia Mañez; Diego M. Maurizi; Mario Melgar; Florencia Mesplet; Carlos Morales Pertuz; Cristina Moreno Izquierdo; Luciana Gabriela Moya; Yanina Nuccetelli; Glendys Núñez; Argelis Olmedo; Belén Palacio; Antonella Pauluzzi; Mariana De Paz Sierra; Florencia Pellice; Loraine Perez Alvear; Carla Lorena Raffo; Fanny Reino; Ligia Vence Reyes; Gerardo Ricoy; Viviana E. Rodriguez; Federico Romero; Juan J. Romero; Mariquena Ruiz; Maria Eugenia Russo; Graciela Sadino; Nancy Sandoval; Natalia Staffolani; Maria Jose Torralvo; Alejandra M. Urueña; Hugo Videla; Marisol Valle; Silvia Vera Amate Perez; Hernan Vergara-Samur; Silvina Villamandos; Olmedo Villarreal; Eduardo Warley; Guadalupe Reyes-Morales; Rodolfo E. Quiros

doi:10.1093/ofid/ofaf364

Multicenter Evaluation of Antibiotic Use and Antibiotic Stewardship Programs in Latin American Hospitals

Valeria Fabre
, Sara E. Cosgrove
, Yea Jen Hsu
, Twisha S. Patel
, Fernanda C. Lessa
, Andrea Alvarado
, Bowen Aquiles
, Ana B. Arauz
, Maria F. Barberis
, Maria Del Carmen Bangher
, Maria P. Bernachea
, Marisa L. Bernan
, Alfredo Canton
, Ximena Castañeda
, Angel M. Colque
, Rosa Contreras
, Wanda Cornistein
, Silvia Mabel Correa
, Gustavo Costilla Campero
, Marta Isabel Chamorro Ayala

Lidia Espinola, Clara Esquivel, Cecilia Ezcurra, Johana Fernandez, Sandra Ferrari, Natalia Frassone, Carlos Garcia Cruz, Maria Isabel Garzón, Carlos H. Gomez Quintero, José A. Gonzalez, Lucrecia Guaymas, Fausto Guerrero-Toapanta, Sandra Lambert, Diego Laplume, Itzel L. Lopez, Herberth Maldonado, Noelia Mañez, Diego M. Maurizi, Mario Melgar, Florencia Mesplet, Carlos Morales Pertuz, Cristina Moreno Izquierdo, Luciana Gabriela Moya, Yanina Nuccetelli, Glendys Núñez, Argelis Olmedo, Belén Palacio, Antonella Pauluzzi, Mariana De Paz Sierra, Florencia Pellice, Loraine Perez Alvear, Carla Lorena Raffo, Fanny Reino, Ligia Vence Reyes, Gerardo Ricoy, Viviana E. Rodriguez, Federico Romero, Juan J. Romero, Mariquena Ruiz, Maria Eugenia Russo, Graciela Sadino, Nancy Sandoval, Natalia Staffolani, Maria Jose Torralvo, Alejandra M. Urueña, Hugo Videla, Marisol Valle, Silvia Vera Amate Perez, Hernan Vergara-Samur, Silvina Villamandos, Olmedo Villarreal, Eduardo Warley, Guadalupe Reyes-Morales, Rodolfo E. Quiros

Johns Hopkins University
Centers for Disease Control and Prevention
Unidad de Cirugia Cardiovascular de Guatemala
Hospital Sociedad de Lucha Contra El Cáncer
University of Panama
Hospital Santo Tomas
Hospital Nacional Profesor Dr. Alejandro Posadas
Instituto de Cardiología de Corrientes Juana Francisca Cabral
Clínica Conciencia
Hospital Interzonal de Agudos General José de San Martín
Hospital Punta Pacifica
Clínica de la Mujer
Hospital Universitario Mayor Méderi
Hospital Medico Policial Churruca Visca
Hospital Dr. Marcial V. Quiroga
Universidad Austral
Hospital Municipal de Trauma Dr. Federico Abete
Hospital Angel C. Padilla
Hospital Zonal General de Agudos Dr. Alberto Eurnekian
Hospital El Cruce
Hospital San Benito
Hospital Alemán
Hospital Dr. Guillermo Rawson
Universidad Católica de Córdoba
Hospital Privado Centro Médico de Córdoba
Hospital Militar Central
Hospital Irma de Lourdes Tzanetatos
Clínica Provincial de Merlo
Hospital Carlos Andrade Marin
Clinica Hospital San Fernando
University of the Valley of Guatemala
Hospital Italiano de Buenos Aires
Hospital Municipal de Agudos Dr. Leonidas Lucero
Hospital Roosevelt
Hospital Cesar Milstein
Hospital Del Tunal
Hospital Metropolitano
Instituto de Diagnostico
Sanatorio Allende
The Panama Clinic
Hospital Vozandes
Maternidad Nuestra Señora de Las Mercedes de Tucumán
Sanatorio Las Lomas

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

BACKGROUND: There is limited knowledge on the extent of antimicrobial stewardship program (ASP) implementation in health care facilities (HCFs) in Latin America.

METHODS: We performed an evaluation of ASPs in Latin American HCFs from March 2022 to February 2023 using a structured self-assessment survey associated with a scoring system that evaluated leadership support and accountability, resources, antibiotic stewardship actions, education, and antibiotic use (AU) monitoring and reporting. Additionally, we collected monthly AU data (antibiotic consumption and point prevalence surveys) and number of multidrug-resistant infections in medical-surgical intensive care units. Self-assessment scores were correlated with AU through multivariable regression models adjusting for bed size, country of HCF, and incidence of infections (when appropriate).

RESULTS: Of the 39 HCFs recruited for the study, all completed the self-assessment, 36 performed the point prevalence survey, and 29 collected antibiotic consumption data. The overall median self-assessment score was 252.5 (IQR, 212.5-285) for a maximum possible score of 335. A high self-assessment score (top quartile) was associated with higher guideline-compliant AU (odds ratio [OR], 8.63; 95% CI, 3.03-24.6; P < .001), higher use of directed therapy (OR, 2.11; 95% CI, 1.41-3.1; P < .001), and less consumption of anti-methicillin-resistant Staphylococcus aureus agents (OR, -8.59; SE = 4.12; P = .037) after adjusting for bed size, country, and incidence of methicillin-resistant S aureus infections.

CONCLUSIONS: Higher-level ASP implementation in Latin American HCFs correlated with better compliance with AU guidelines and decreased the use of vancomycin in the intensive care unit, supporting the need to improve resources for ASPs.

Original language	English
Article number	ofaf364
Pages (from-to)	ofaf364
Journal	Open Forum Infectious Diseases
Volume	12
Issue number	7
DOIs	https://doi.org/10.1093/ofid/ofaf364
State	Published - 1 Jul 2025

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Latin America
antibiotic use
implementation
resources
stewardship

Centers and Institutes Mederi

Infectious Diseases and Tropical Medicine Institute

Access to Document

10.1093/ofid/ofaf364

Cite this

Fabre, V., Cosgrove, S. E., Hsu, Y. J., Patel, T. S., Lessa, F. C., Alvarado, A., Aquiles, B., Arauz, A. B., Barberis, M. F., Bangher, M. D. C., Bernachea, M. P., Bernan, M. L., Canton, A., Castañeda, X., Colque, A. M., Contreras, R., Cornistein, W., Correa, S. M., Costilla Campero, G., ... Quiros, R. E. (2025). Multicenter Evaluation of Antibiotic Use and Antibiotic Stewardship Programs in Latin American Hospitals. Open Forum Infectious Diseases, 12(7), ofaf364. Article ofaf364. https://doi.org/10.1093/ofid/ofaf364

@article{8f159c27f29e4abf9506dc32749c515b,

title = "Multicenter Evaluation of Antibiotic Use and Antibiotic Stewardship Programs in Latin American Hospitals",

abstract = "BACKGROUND: There is limited knowledge on the extent of antimicrobial stewardship program (ASP) implementation in health care facilities (HCFs) in Latin America.METHODS: We performed an evaluation of ASPs in Latin American HCFs from March 2022 to February 2023 using a structured self-assessment survey associated with a scoring system that evaluated leadership support and accountability, resources, antibiotic stewardship actions, education, and antibiotic use (AU) monitoring and reporting. Additionally, we collected monthly AU data (antibiotic consumption and point prevalence surveys) and number of multidrug-resistant infections in medical-surgical intensive care units. Self-assessment scores were correlated with AU through multivariable regression models adjusting for bed size, country of HCF, and incidence of infections (when appropriate).RESULTS: Of the 39 HCFs recruited for the study, all completed the self-assessment, 36 performed the point prevalence survey, and 29 collected antibiotic consumption data. The overall median self-assessment score was 252.5 (IQR, 212.5-285) for a maximum possible score of 335. A high self-assessment score (top quartile) was associated with higher guideline-compliant AU (odds ratio [OR], 8.63; 95\% CI, 3.03-24.6; P < .001), higher use of directed therapy (OR, 2.11; 95\% CI, 1.41-3.1; P < .001), and less consumption of anti-methicillin-resistant Staphylococcus aureus agents (OR, -8.59; SE = 4.12; P = .037) after adjusting for bed size, country, and incidence of methicillin-resistant S aureus infections. CONCLUSIONS: Higher-level ASP implementation in Latin American HCFs correlated with better compliance with AU guidelines and decreased the use of vancomycin in the intensive care unit, supporting the need to improve resources for ASPs.",

keywords = "Latin America, antibiotic use, implementation, resources, stewardship",

author = "Valeria Fabre and Cosgrove, \{Sara E.\} and Hsu, \{Yea Jen\} and Patel, \{Twisha S.\} and Lessa, \{Fernanda C.\} and Andrea Alvarado and Bowen Aquiles and Arauz, \{Ana B.\} and Barberis, \{Maria F.\} and Bangher, \{Maria Del Carmen\} and Bernachea, \{Maria P.\} and Bernan, \{Marisa L.\} and Alfredo Canton and Ximena Casta{\~n}eda and Colque, \{Angel M.\} and Rosa Contreras and Wanda Cornistein and Correa, \{Silvia Mabel\} and \{Costilla Campero\}, Gustavo and \{Chamorro Ayala\}, \{Marta Isabel\} and Lidia Espinola and Clara Esquivel and Cecilia Ezcurra and Johana Fernandez and Sandra Ferrari and Natalia Frassone and \{Garcia Cruz\}, Carlos and Garz{\'o}n, \{Maria Isabel\} and \{Gomez Quintero\}, \{Carlos H.\} and Gonzalez, \{Jos{\'e} A.\} and Lucrecia Guaymas and Fausto Guerrero-Toapanta and Sandra Lambert and Diego Laplume and Lopez, \{Itzel L.\} and Herberth Maldonado and Noelia Ma{\~n}ez and Maurizi, \{Diego M.\} and Mario Melgar and Florencia Mesplet and \{Morales Pertuz\}, Carlos and \{Moreno Izquierdo\}, Cristina and Moya, \{Luciana Gabriela\} and Yanina Nuccetelli and Glendys N{\'u}{\~n}ez and Argelis Olmedo and Bel{\'e}n Palacio and Antonella Pauluzzi and \{De Paz Sierra\}, Mariana and Florencia Pellice and \{Perez Alvear\}, Loraine and Raffo, \{Carla Lorena\} and Fanny Reino and \{Vence Reyes\}, Ligia and Gerardo Ricoy and Rodriguez, \{Viviana E.\} and Federico Romero and Romero, \{Juan J.\} and Mariquena Ruiz and Russo, \{Maria Eugenia\} and Graciela Sadino and Nancy Sandoval and Natalia Staffolani and Torralvo, \{Maria Jose\} and Urue{\~n}a, \{Alejandra M.\} and Hugo Videla and Marisol Valle and \{Vera Amate Perez\}, Silvia and Hernan Vergara-Samur and Silvina Villamandos and Olmedo Villarreal and Eduardo Warley and Guadalupe Reyes-Morales and Quiros, \{Rodolfo E.\}",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s). Published by Oxford University Press on behalf of Infectious Diseases Society of America.",

year = "2025",

month = jul,

day = "1",

doi = "10.1093/ofid/ofaf364",

language = "Ingl{\'e}s",

volume = "12",

pages = "ofaf364",

journal = "Open Forum Infectious Diseases",

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Fabre, V, Cosgrove, SE, Hsu, YJ, Patel, TS, Lessa, FC, Alvarado, A, Aquiles, B, Arauz, AB, Barberis, MF, Bangher, MDC, Bernachea, MP, Bernan, ML, Canton, A, Castañeda, X, Colque, AM, Contreras, R, Cornistein, W, Correa, SM, Costilla Campero, G, Chamorro Ayala, MI, Espinola, L, Esquivel, C, Ezcurra, C, Fernandez, J, Ferrari, S, Frassone, N, Garcia Cruz, C, Garzón, MI, Gomez Quintero, CH, Gonzalez, JA, Guaymas, L, Guerrero-Toapanta, F, Lambert, S, Laplume, D, Lopez, IL, Maldonado, H, Mañez, N, Maurizi, DM, Melgar, M, Mesplet, F, Morales Pertuz, C, Moreno Izquierdo, C, Moya, LG, Nuccetelli, Y, Núñez, G, Olmedo, A, Palacio, B, Pauluzzi, A, De Paz Sierra, M, Pellice, F, Perez Alvear, L, Raffo, CL, Reino, F, Vence Reyes, L, Ricoy, G, Rodriguez, VE, Romero, F, Romero, JJ, Ruiz, M, Russo, ME, Sadino, G, Sandoval, N, Staffolani, N, Torralvo, MJ, Urueña, AM, Videla, H, Valle, M, Vera Amate Perez, S, Vergara-Samur, H, Villamandos, S, Villarreal, O, Warley, E, Reyes-Morales, G & Quiros, RE 2025, 'Multicenter Evaluation of Antibiotic Use and Antibiotic Stewardship Programs in Latin American Hospitals', Open Forum Infectious Diseases, vol. 12, no. 7, ofaf364, pp. ofaf364. https://doi.org/10.1093/ofid/ofaf364

TY - JOUR

T1 - Multicenter Evaluation of Antibiotic Use and Antibiotic Stewardship Programs in Latin American Hospitals

AU - Fabre, Valeria

AU - Cosgrove, Sara E.

AU - Hsu, Yea Jen

AU - Patel, Twisha S.

AU - Lessa, Fernanda C.

AU - Alvarado, Andrea

AU - Aquiles, Bowen

AU - Arauz, Ana B.

AU - Barberis, Maria F.

AU - Bangher, Maria Del Carmen

AU - Bernachea, Maria P.

AU - Bernan, Marisa L.

AU - Canton, Alfredo

AU - Castañeda, Ximena

AU - Colque, Angel M.

AU - Contreras, Rosa

AU - Cornistein, Wanda

AU - Correa, Silvia Mabel

AU - Costilla Campero, Gustavo

AU - Chamorro Ayala, Marta Isabel

AU - Espinola, Lidia

AU - Esquivel, Clara

AU - Ezcurra, Cecilia

AU - Fernandez, Johana

AU - Ferrari, Sandra

AU - Frassone, Natalia

AU - Garcia Cruz, Carlos

AU - Garzón, Maria Isabel

AU - Gomez Quintero, Carlos H.

AU - Gonzalez, José A.

AU - Guaymas, Lucrecia

AU - Guerrero-Toapanta, Fausto

AU - Lambert, Sandra

AU - Laplume, Diego

AU - Lopez, Itzel L.

AU - Maldonado, Herberth

AU - Mañez, Noelia

AU - Maurizi, Diego M.

AU - Melgar, Mario

AU - Mesplet, Florencia

AU - Morales Pertuz, Carlos

AU - Moreno Izquierdo, Cristina

AU - Moya, Luciana Gabriela

AU - Nuccetelli, Yanina

AU - Núñez, Glendys

AU - Olmedo, Argelis

AU - Palacio, Belén

AU - Pauluzzi, Antonella

AU - De Paz Sierra, Mariana

AU - Pellice, Florencia

AU - Perez Alvear, Loraine

AU - Raffo, Carla Lorena

AU - Reino, Fanny

AU - Vence Reyes, Ligia

AU - Ricoy, Gerardo

AU - Rodriguez, Viviana E.

AU - Romero, Federico

AU - Romero, Juan J.

AU - Ruiz, Mariquena

AU - Russo, Maria Eugenia

AU - Sadino, Graciela

AU - Sandoval, Nancy

AU - Staffolani, Natalia

AU - Torralvo, Maria Jose

AU - Urueña, Alejandra M.

AU - Videla, Hugo

AU - Valle, Marisol

AU - Vera Amate Perez, Silvia

AU - Vergara-Samur, Hernan

AU - Villamandos, Silvina

AU - Villarreal, Olmedo

AU - Warley, Eduardo

AU - Reyes-Morales, Guadalupe

AU - Quiros, Rodolfo E.

PY - 2025/7/1

Y1 - 2025/7/1

N2 - BACKGROUND: There is limited knowledge on the extent of antimicrobial stewardship program (ASP) implementation in health care facilities (HCFs) in Latin America.METHODS: We performed an evaluation of ASPs in Latin American HCFs from March 2022 to February 2023 using a structured self-assessment survey associated with a scoring system that evaluated leadership support and accountability, resources, antibiotic stewardship actions, education, and antibiotic use (AU) monitoring and reporting. Additionally, we collected monthly AU data (antibiotic consumption and point prevalence surveys) and number of multidrug-resistant infections in medical-surgical intensive care units. Self-assessment scores were correlated with AU through multivariable regression models adjusting for bed size, country of HCF, and incidence of infections (when appropriate).RESULTS: Of the 39 HCFs recruited for the study, all completed the self-assessment, 36 performed the point prevalence survey, and 29 collected antibiotic consumption data. The overall median self-assessment score was 252.5 (IQR, 212.5-285) for a maximum possible score of 335. A high self-assessment score (top quartile) was associated with higher guideline-compliant AU (odds ratio [OR], 8.63; 95% CI, 3.03-24.6; P < .001), higher use of directed therapy (OR, 2.11; 95% CI, 1.41-3.1; P < .001), and less consumption of anti-methicillin-resistant Staphylococcus aureus agents (OR, -8.59; SE = 4.12; P = .037) after adjusting for bed size, country, and incidence of methicillin-resistant S aureus infections. CONCLUSIONS: Higher-level ASP implementation in Latin American HCFs correlated with better compliance with AU guidelines and decreased the use of vancomycin in the intensive care unit, supporting the need to improve resources for ASPs.

AB - BACKGROUND: There is limited knowledge on the extent of antimicrobial stewardship program (ASP) implementation in health care facilities (HCFs) in Latin America.METHODS: We performed an evaluation of ASPs in Latin American HCFs from March 2022 to February 2023 using a structured self-assessment survey associated with a scoring system that evaluated leadership support and accountability, resources, antibiotic stewardship actions, education, and antibiotic use (AU) monitoring and reporting. Additionally, we collected monthly AU data (antibiotic consumption and point prevalence surveys) and number of multidrug-resistant infections in medical-surgical intensive care units. Self-assessment scores were correlated with AU through multivariable regression models adjusting for bed size, country of HCF, and incidence of infections (when appropriate).RESULTS: Of the 39 HCFs recruited for the study, all completed the self-assessment, 36 performed the point prevalence survey, and 29 collected antibiotic consumption data. The overall median self-assessment score was 252.5 (IQR, 212.5-285) for a maximum possible score of 335. A high self-assessment score (top quartile) was associated with higher guideline-compliant AU (odds ratio [OR], 8.63; 95% CI, 3.03-24.6; P < .001), higher use of directed therapy (OR, 2.11; 95% CI, 1.41-3.1; P < .001), and less consumption of anti-methicillin-resistant Staphylococcus aureus agents (OR, -8.59; SE = 4.12; P = .037) after adjusting for bed size, country, and incidence of methicillin-resistant S aureus infections. CONCLUSIONS: Higher-level ASP implementation in Latin American HCFs correlated with better compliance with AU guidelines and decreased the use of vancomycin in the intensive care unit, supporting the need to improve resources for ASPs.

KW - Latin America

KW - antibiotic use

KW - implementation

KW - resources

KW - stewardship

UR - https://www.scopus.com/pages/publications/105011249665

U2 - 10.1093/ofid/ofaf364

DO - 10.1093/ofid/ofaf364

M3 - Artículo

C2 - 40689250

AN - SCOPUS:105011249665

SN - 2328-8957

VL - 12

SP - ofaf364

JO - Open Forum Infectious Diseases

JF - Open Forum Infectious Diseases

IS - 7

M1 - ofaf364

ER -

Multicenter Evaluation of Antibiotic Use and Antibiotic Stewardship Programs in Latin American Hospitals

Abstract

UN SDGs

Keywords

Centers and Institutes Mederi

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