# Impact of an Antimicrobial Stewardship Program on Antibiotic Consumption, Bacterial Susceptibility, and Costs in a High-Complexity Public Hospital

## TL;DR

An antimicrobial stewardship program in a Brazilian hospital reduced antibiotic use, improved bacterial susceptibility, and saved costs over four years.

## Contribution

Demonstrates the clinical, ecological, and economic benefits of an ASP in a high-complexity public hospital setting.

## Key findings

- Significant and sustained reductions in antibiotic use for all agents except polymyxin B.
- Improved or stabilized susceptibility among key Gram-negative pathogens after ASP implementation.
- Annual antimicrobial costs decreased by approximately USD 174,000.

## Abstract

Background/Objectives: Antimicrobial resistance (AMR) is a major global public health threat, particularly in hospitals. Antimicrobial Stewardship Programs (ASPs) aim to optimize prescribing, reduce unnecessary exposure to broad-spectrum agents, and mitigate resistance. This study evaluated the clinical, ecological, and economic impact of an ASP implemented in January 2021 in a high-complexity hospital in Brazil, focusing on antimicrobial consumption, temporal trends in bacterial susceptibility, and direct antimicrobial-related costs. Methods: A quasi-experimental pre–post study using an interrupted time-series design was conducted in the adult intensive care unit from January 2019 to December 2023. Antimicrobial consumption was measured as Defined Daily Doses per 1000 patient-days (DDD/1000-PD) for ceftriaxone, meropenem, piperacillin–tazobactam, vancomycin, and polymyxin B. Temporal trends were assessed using Joinpoint regression, and pre- and post-intervention periods were compared using Student’s or Mann–Whitney tests. Susceptibility data were interpreted according to BrCAST standards. Results: Significant and sustained reductions were observed for all agents except polymyxin B. Susceptibility improved or stabilized among key Gram-negative pathogens, with a significant increase in aggregated Gram-negative susceptibility after 2021, while intrinsically resistant organisms showed limited change. Annual antimicrobial costs decreased by approximately USD 174,000. Conclusions: The ASP was associated with reduced broad-spectrum antimicrobial use, favorable ecological trends, and substantial cost savings.