P-1684. Characterization of Bacteremia and de-escalation practices among 13 public hospitals in Chile: Results from the 2022-2023 Chilean PPS

TL;DR

This study analyzed antimicrobial use in Chilean hospitals to assess de-escalation practices and bacteremia treatment based on blood culture results.

Contribution

The study provides the first data on de-escalation practices in Latin America based on blood culture results for bacteremia.

Findings

Staphylococcus aureus was the most common cause of bacteremia.

75.5% of bacteremia cases had an organism matching an appropriate antimicrobial.

Opportunities for antimicrobial optimization were identified through de-escalation or stopping treatment.

Abstract

Antimicrobial resistance (AMR) is a global concern. Collecting data and implementing interventions to optimize antimicrobial (AM) use has significant potential to lower AMR.There is no information in Latin American Region on how prescribers are using data from positive blood culture results to de-escalate AM. We present a sub-analysis of the 2022-2023 Latin-PPS performed in Chile including the characterization of bacteriemia and de-escalation practices.

Antimicrobial distribution to treat bacteremia

13 public hospitals joined the Latin-PPS group. This PPS is based on the WHOPPS methodology. Each hospital conducted a survey in which everyday data from AM prescriptions was collected by ward. We include only patients that received AM related to documented bacteremia. The purpose of this study is to describe the etiological agents that caused bacteremia, AM use and compare the blood culture result with appropriate AM prescription.

Most common etiological agents and antimicrobials used.

Chilean PPS included 3,342 beds, where 1302 AM treatments were given and 1,928 AM were administered to a national prevalence of 38.84%. Bacteremia is the 6th most common diagnosis related to AM use and corresponds to 3,76% . We found 49 bacteremia episodes, 9 occurred in ICU. The most common etiological agent was Staphylococcus aureus (16/49). Table 1 describes: most common etiological agents and AM used. The AM distribution to treat bacteremia is shown in graphic 1.

37/49 (75.5%) bacteremia had an organism that matched an appropriate AM. 10 of those missed an opportunity of de-escalation and 7 possibly represented contaminations in which AM could be stopped.

The AM prescription in hospitalized patients in Chile is lower compared to other LMIC. We found opportunities for AM optimization by de-escalating or stopping AM when blood culture results are available in bacteremia. We plan to recommend evidence-based strategies implementation aiming to de-escalate AM to a narrow more tailored regimen by audit and feedback supported with guidelines. Also to raise awareness about the possibility of contamination when blood cultures isolate coagulase negative staphylococcus as an opportunity to stop antimicrobials. PPS is an effective method to detect antimicrobial prescription habits and prioritize Antimicrobial Stewardship activities with local data.

Dona Benadof, MD, Biomerieux: Grant/Research Support Mirta Acuña, MD, Pfizer: Grant/Research Support P. , PharmD, Eli Lilly: Stocks/Bonds (Private Company)|MSD: Advisor/Consultant|Pfizer: Advisor/Consultant Ruth A. Rosales, n/a, BECTON DICKINSON DE CHILE: Advisor/Consultant|BECTON DICKINSON DE CHILE: Speaker|Pfizer SA: Speaker

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