Antimicrobial stewardship outcomes in a medium-sized Itajaí Valley hospital

Abstract

Objectives: Antimicrobial resistance is a major healthcare challenge, reducing treatment effectiveness and raising infection risks. Antimicrobial Stewardship Programs (ASP) aim to optimize medicine use and curb resistant strains. This study evaluates the impact of ASP implementation in a medium-sized teaching hospital in Southern Brazil by measuring changes in antimicrobial use with Defined Daily Dose (DDD) and Days of Therapy (DOT). Methods: This study retrospectively reviews electronic medical record data from September 2023 to September 2024 across three care areas: Intensive Care Unit (ICU), Medical Clinic, and Surgical Clinic. Data were compared between pre- and post-implementation periods of the ASP using the Mann–Whitney test. Results: Following ASP implementation, significant reductions were observed in the use of carbapenems, in the ICU (13.0%) and in the Surgical Clinic (68.5%), as well as fluoroquinolones in the ICU (41.4%). In contrast, penicillin combined with β-lactamase inhibitors increased substantially in the Medical Clinic (115.3%), suggesting a therapeutic shift toward safer agents. Fourth-generation cephalosporins and glycopeptides displayed localized increases consistent with rationalization of empirical and targeted therapy. For these agents, there was an 11.3% decrease in DDD within the ICU (11.3%), whereas there were increases in the Medical (18.7%) and Surgical Clinics (3.1%). Conclusion: The implementation of the ASP effectively modulated antimicrobial consumption, reducing the use of high-risk broad-spectrum agents while promoting rational alternatives. These findings demonstrate that ASPs can yield measurable benefits even in resource-limited hospital settings, reinforcing the need for continuous surveillance using DDD and DOT indicators to sustain progress against antimicrobial resistance.