Quantitative analysis of the implementation status of rational antimicrobial use programs in public institutions in Chile

Abstract

Background: Antimicrobial resistance is a growing global threat, and the overuse of antibiotics is one of its main causes. This study analyzes the implementation of Antimicrobial Stewardship Programs (ASPs) in 26 high-complexity public hospitals in Chile. It evaluates the relationship between the structure, processes, and outcomes of the programs with antibiotic use. The findings will help understand the impact of these initiatives on the management of antibiotic use. Aim: To analyze the implementation status of ASP in high-complexity hospitals in Chile and determine the association between available resources and strategies with total antibiotic consumption and the use of restricted antibiotics. Methods: A survey was conducted with clinical pharmacists from 26 public high-complexity hospitals, using a validated 100-point scale divided into two categories: resources (60 points) and strategies (40 points). The survey was designed using the SurveyMonkey platform, and data on antimicrobial consumption in defined daily doses (DDD) per 100 bed-days were collected. Results and Analysis: Of the 26 responding hospitals, 92.3% have a formalized ASP team in 95.8% of cases. The majority of these teams include physicians (91.7%) and pharmacists (83.3%). The median total score was 49 points, with 17.5 for resources and 32 for strategies. The average antimicrobial consumption in the intensive care unit was 6.50 DDD/100 bed-days, compared to 1.89 DDD/100 bed-days in the medicine area. Despite the formalization of ASP teams, no significant association was found between the scores of resources and strategies and antimicrobial consumption; however, a trend suggested that greater access to resources might be associated with reduced antimicrobial use. Conclusions: Most high-complexity hospitals in Chile exhibit deficiencies in human resources and management for the effective implementation of ASPs. The research highlights the need to improve the availability of full-time staff and the use of technological tools to optimize antimicrobial use. Future studies are recommended to expand the sample size and analyze more deeply the relationship between strategies and antimicrobial consumption.