{
  "abstract": "Background There is limited evidence from antimicrobial stewardship programmes in less-resourced settings. This study aimed to improve the quality of antibacterial prescriptions by mitigating overuse and promoting the use of narrow-spectrum agents in intensive care units (ICUs) in a middle-income country.Methods We established a quality improvement collaborative (QIC) model involving nine Argentine ICUs over 11 months with a 16-week baseline period (BP) and a 32-week implementation period (IP). Our intervention package included audits and feedback on antibacterial use, facility-specific treatment guidelines, antibacterial timeouts, pharmacy-based interventions and education. The intervention was delivered in two learning sessions with three action periods along with coaching support and basic quality improvement training.Results We included 912 patients, 357 in BP and 555 in IP. The latter had higher APACHE II (17 (95% CI: 12 to 21) vs 15 (95% CI: 11 to 20), p=0.036), SOFA scores (6 (95% CI: 4 to 9) vs 5 (95% CI: 3 to 8), p=0.006), renal failure (41.6% vs 33.1%, p=0.009), sepsis (36.1% vs 31.6%, p<0.001) and septic shock (40.0% vs 33.8%, p<0.001). The days of antibacterial therapy (DOT) were similar between the groups (change in the slope from BP to IP 28.1 (95% CI: −17.4 to 73.5), p=0.2405). There were no differences in the antibacterial defined daily dose (DDD) between the groups (change in the slope from BP to IP 43.9, (95% CI: −12.3 to 100.0), p=0.1413).The rate of antibacterial de-escalation based on microbiological culture was higher during the IP (62.0% vs 45.3%, p<0.001).The infection prevention control (IPC) assessment framework was increased in eight ICUs.Conclusion Implementing an antimicrobial stewardship program in ICUs in a middle-income country via a QIC demonstrated success in improving antibacterial de-escalation based on microbiological culture results, but not on DOT or DDD. In addition, eight out of nine ICUs improved their IPC Assessment Framework Score.",
  "authors": [
    {
      "affiliations": [
        "Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina",
        "PICU, Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina"
      ],
      "name": "Facundo Jorro-Baron"
    },
    {
      "affiliations": [
        "Hospital Interzonal General de Agudos General San Martín, La Plata, Argentina",
        "Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina"
      ],
      "name": "Cecilia Inés Loudet"
    },
    {
      "affiliations": [
        "Sociedad Argentina de Infectología, Ciudad Autónoma de Buenos Aires, Argentina"
      ],
      "name": "Wanda Cornistein"
    },
    {
      "affiliations": [
        "Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina"
      ],
      "name": "Inés Suarez-Anzorena"
    },
    {
      "affiliations": [
        "Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina"
      ],
      "name": "Pilar Arias-Lopez"
    },
    {
      "affiliations": [
        "Hospital General de Agudos Dr Ignacio Pirovano, Buenos Aires, Argentina"
      ],
      "name": "Carina Balasini"
    },
    {
      "affiliations": [
        "Intensive Care Unit, Hospital Pablo Soria, Jujuy, Argentina"
      ],
      "name": "Laura Cabana"
    },
    {
      "affiliations": [
        "Intensive Care Unit, Hospital de Infecciosas Dr Francisco Javier Muñiz, Buenos Aires, Argentina"
      ],
      "name": "Eleonora Cunto"
    },
    {
      "affiliations": [
        "Hospital Evita de Lanús, Buenos Aires, Argentina"
      ],
      "name": "Pablo Rodrigo Jorge Corral"
    },
    {
      "affiliations": [
        "Instituto de Efectividad Clinica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina"
      ],
      "name": "Luz Gibbons"
    },
    {
      "affiliations": [
        "Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina"
      ],
      "name": "Marina Guglielmino"
    },
    {
      "affiliations": [
        "Intensive Care Unit, Hospital Simplemente Evita, Buenos Aires, Argentina"
      ],
      "name": "Gabriela Izzo"
    },
    {
      "affiliations": [
        "Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina"
      ],
      "name": "Marianela Lescano"
    },
    {
      "affiliations": [
        "Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina"
      ],
      "name": "Claudia Meregalli"
    },
    {
      "affiliations": [
        "Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina",
        "Intensive Care Unit, Hospital Francisco López-Lima, Río Negro, Argentina"
      ],
      "name": "Cristina Orlandi"
    },
    {
      "affiliations": [
        "Intensive Care Unit, Hospital Provincial de Neuquén Dr Castro Rendón, Neuquen, Argentina"
      ],
      "name": "Fernando Perre"
    },
    {
      "affiliations": [
        "Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina"
      ],
      "name": "Maria Elena Ratto"
    },
    {
      "affiliations": [
        "Hospital General de Agudos Bernardino Rivadavia, Buenos Aires, Argentina"
      ],
      "name": "Mariano Rivet"
    },
    {
      "affiliations": [
        "Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina"
      ],
      "name": "Ana Paula Rodriguez"
    },
    {
      "affiliations": [
        "Sociedad Argentina de Infectología, Ciudad Autónoma de Buenos Aires, Argentina"
      ],
      "name": "Viviana Monica Rodriguez"
    },
    {
      "affiliations": [
        "Hospital Interzonal General de Agudos General San Martín, La Plata, Argentina"
      ],
      "name": "Jacqueline Vilca Becerra"
    },
    {
      "affiliations": [
        "Intensive Care Unit, Hospital Francisco López-Lima, Río Negro, Argentina"
      ],
      "name": "Paula Romina Villegas"
    },
    {
      "affiliations": [
        "Instituto de Efectividad Clinica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina"
      ],
      "name": "Emilse Vitar"
    },
    {
      "affiliations": [
        "Instituto de Efectividad Clinica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina"
      ],
      "name": "Javier Roberti"
    },
    {
      "affiliations": [
        "Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina"
      ],
      "name": "Ezequiel García-Elorrio"
    },
    {
      "affiliations": [
        "Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina",
        "PICU, Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina",
        "Hospital Interzonal General de Agudos General San Martín, La Plata, Argentina",
        "Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina",
        "Sociedad Argentina de Infectología, Ciudad Autónoma de Buenos Aires, Argentina",
        "Hospital General de Agudos Dr Ignacio Pirovano, Buenos Aires, Argentina",
        "Intensive Care Unit, Hospital Pablo Soria, Jujuy, Argentina",
        "Intensive Care Unit, Hospital de Infecciosas Dr Francisco Javier Muñiz, Buenos Aires, Argentina",
        "Hospital Evita de Lanús, Buenos Aires, Argentina",
        "Instituto de Efectividad Clinica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina",
        "Intensive Care Unit, Hospital Simplemente Evita, Buenos Aires, Argentina",
        "Intensive Care Unit, Hospital Francisco López-Lima, Río Negro, Argentina",
        "Intensive Care Unit, Hospital Provincial de Neuquén Dr Castro Rendón, Neuquen, Argentina",
        "Hospital General de Agudos Bernardino Rivadavia, Buenos Aires, Argentina"
      ],
      "name": "COST Collaborative Group"
    },
    {
      "affiliations": [
        "Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina"
      ],
      "name": "Viviana Rodriguez"
    }
  ],
  "title": "Optimising antibacterial utilisation in Argentine intensive care units: a quality improvement collaborative",
  "uid": "bc236da6-0b75-5f13-8ac0-5cd4c2c0b249"
}