{
  "abstract": "Background and Importance Rational use of antimicrobials is essential to prevent resistance, improve clinical outcomes, and reduce healthcare costs. In regional hospitals, implementing antimicrobial stewardship programs (ASP) is particularly relevant due to limited resources.Aim and Objectives To evaluate the adequacy of broad-spectrum antimicrobial treatments and analyse the pharmaceutical interventions performed.Material and Methods A retrospective observational study was carried out at a regional hospital over a 4 month period (June-September 2025). All treatments involving the following antimicrobials under special control were reviewed: piperacillin-tazobactam, carbapenems, vancomycin, linezolid, daptomycin, voriconazole, and liposomal amphotericin B. Collected variables included: age, sex, renal clearance, prescribing service, clinical indication, prior and concomitant antibiotic use, adherence to clinical guidelines, microbiological cultures and results, as well as pharmaceutical interventions (de-escalation, dose adjustment, treatment duration, sequential therapy) and their acceptance by the medical team.Results A total of 196 patients (55% male) were included, with a mean age of 78.5 ± 13.5 years. The departments with the highest number of prescriptions were Internal Medicine (46%), Surgery (18%) and Oncology (13%). Piperacillin-tazobactam was the most frequently prescribed antimicrobial (59%), followed by meropenem (12%) and vancomycin (10%). Adherence to clinical guidelines was 64%. A total of 58 pharmaceutical interventions were made, with 80% accepted. The most common interventions were: de-escalation (62%), sequential therapy (17%), and dose adjustment (14%). In 85% of cases, initial treatment was started empirically without microbiological results available; the remaining prescriptions were adjusted after obtaining positive microbiological results, favouring therapeutic adequacy. These interventions optimised antimicrobial use, minimised adverse effects, and contributed to reducing bacterial resistance in the centre.Conclusion and Relevance Active pharmaceutical monitoring of antimicrobial treatments allows identification of opportunities to improve prescribing practices, optimise pharmacotherapy, and reduce associated risks. The integration of hospital pharmacists into ASP demonstrates their significant contribution to enhancing care quality and patient safety. The high acceptance rate of interventions (80%) reflects effective multidisciplinary collaboration and demonstrates the feasibility of implementing optimisation strategies in regional hospitals.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "Hospital Comarcal Santiago Apostol, Pharmacy, Miranda De Ebro Burgos, Spain"
      ],
      "name": "MDC Gonzalez Escribano"
    },
    {
      "affiliations": [
        "Hospital Comarcal Santiago Apostol, Pharmacy, Miranda De Ebro Burgos, Spain"
      ],
      "name": "JJ Saiz Molina"
    },
    {
      "affiliations": [
        "Hospital Comarcal Santiago Apostol, Pharmacy, Miranda De Ebro Burgos, Spain"
      ],
      "name": "L Sanchez Luque"
    },
    {
      "affiliations": [
        "Hospital Comarcal Santiago Apostol, Pharmacy, Miranda De Ebro Burgos, Spain"
      ],
      "name": "CV Hermida Perez"
    }
  ],
  "title": "4CPS-150 Optimisation of antimicrobial use in a regional hospital: prescription and adequacy analysis",
  "uid": "b8a6c83f-a410-5095-9e92-65bd47b184c4"
}