Clinical and economic impact of the implementation of an antimicrobial stewardship program in four Colombian healthcare institutions

Background Despite multiple reports of the benefits of antimicrobial stewardship programs (ASPs) in developed countries, regarding patient safety, decrease in antimicrobial resistance, consumption and spending on antimicrobials, there is very limited evidence of the same benefits in a different economic and social context. The objective of this study was to evaluate the clinical and economic impact of the implementation of an ASP in Colombia. Methods We conducted a multicenter, quasi-experimental cohort study in four Colombian healthcare institutions between 2007 and 2014 including 900 patients (429 patients before and 471 after the implementation of the ASP) to evaluate the impact of these programs. Results Compared to the pre-ASP, the post-ASP group showed a greater adherence to the use of the empirical therapy and de-escalation based on the guidelines (45% vs. 9% and 92% vs. 8%, respectively; p < 0.001), as well as a higher proportion of clinical cure at the end of treatment and lower mortality (93% vs. 74% and 14% vs. 28%, respectively; p < 0.001). In the post-ASP patient group the opportunity for clinical improvement was 10 times greater compared with the pre-ASP group (adjusted OR = 10.40 95% CI 1.21-89.41) and there were less complications following targeted management (adjusted OR = 0.49 95% CI 0.25-0.97). Furthermore, after the implementation of the ASP there was lower average expenditure associated with hospital stay, laboratory tests, infectious diseases consultation, and empirical antimicrobial therapy choice. Conclusion With this study, we were able to show that even in limited income countries, ASPs are feasible to implement.