{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T19:56:01Z","timestamp":1792612561367,"version":"4.5.0"},"reference-count":39,"publisher":"BMJ","issue":"9","funder":[{"DOI":"10.13039\/100008648","name":"Pfizer Foundation","doi-asserted-by":"publisher","award":["PFIZER COMPETITIVE GRANT PROGRAM ID: 68339261"],"award-info":[{"award-number":["PFIZER COMPETITIVE GRANT PROGRAM ID: 68339261"]}],"id":[{"id":"10.13039\/100008648","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2024,8,5]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>There is limited evidence from antimicrobial stewardship programmes in less-resourced settings. This study aimed to improve the quality of antibacterial prescriptions by mitigating overuse and promoting the use of narrow-spectrum agents in intensive care units (ICUs) in a middle-income country.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We established a quality improvement collaborative (QIC) model involving nine Argentine ICUs over 11 months with a 16-week baseline period (BP) and a 32-week implementation period (IP). Our intervention package included audits and feedback on antibacterial use, facility-specific treatment guidelines, antibacterial timeouts, pharmacy-based interventions and education. The intervention was delivered in two learning sessions with three action periods along with coaching support and basic quality improvement training.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 912 patients, 357 in BP and 555 in IP. The latter had higher APACHE II (17 (95% CI: 12 to 21) vs 15 (95% CI: 11 to 20), p=0.036), SOFA scores (6 (95% CI: 4 to 9) vs 5 (95% CI: 3 to 8), p=0.006), renal failure (41.6% vs 33.1%, p=0.009), sepsis (36.1% vs 31.6%, p&lt;0.001) and septic shock (40.0% vs 33.8%, p&lt;0.001). The days of antibacterial therapy (DOT) were similar between the groups (change in the slope from BP to IP 28.1 (95% CI: \u221217.4 to 73.5), p=0.2405). There were no differences in the antibacterial defined daily dose (DDD) between the groups (change in the slope from BP to IP 43.9, (95% CI: \u221212.3 to 100.0), p=0.1413).<\/jats:p>\n                    <jats:p>The rate of antibacterial de-escalation based on microbiological culture was higher during the IP (62.0% vs 45.3%, p&lt;0.001).<\/jats:p>\n                    <jats:p>The infection prevention control (IPC) assessment framework was increased in eight ICUs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Implementing an antimicrobial stewardship program in ICUs in a middle-income country via a QIC demonstrated success in improving antibacterial de-escalation based on microbiological culture results, but not on DOT or DDD. In addition, eight out of nine ICUs improved their IPC Assessment Framework Score.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjqs-2024-017069","type":"journal-article","created":{"date-parts":[[2024,8,15]],"date-time":"2024-08-15T13:20:19Z","timestamp":1723728019000},"page":"590-600","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Optimising antibacterial utilisation in Argentine intensive care units: a quality improvement collaborative"],"prefix":"10.1136","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6887-9275","authenticated-orcid":false,"given":"Facundo","family":"Jorro-Baron","sequence":"first","affiliation":[{"name":"Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina"},{"name":"PICU, Hospital General de Ni\u00f1os Pedro de Elizalde, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1647-5110","authenticated-orcid":false,"given":"Cecilia In\u00e9s","family":"Loudet","sequence":"additional","affiliation":[{"name":"Hospital Interzonal General de Agudos General San Mart\u00edn, La Plata, Argentina"},{"name":"Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanda","family":"Cornistein","sequence":"additional","affiliation":[{"name":"Sociedad Argentina de Infectolog\u00eda, Ciudad Aut\u00f3noma de Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In\u00e9s","family":"Suarez-Anzorena","sequence":"additional","affiliation":[{"name":"Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pilar","family":"Arias-Lopez","sequence":"additional","affiliation":[{"name":"Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carina","family":"Balasini","sequence":"additional","affiliation":[{"name":"Hospital General de Agudos Dr Ignacio Pirovano, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Cabana","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Hospital Pablo Soria, Jujuy, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora","family":"Cunto","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Hospital de Infecciosas Dr Francisco Javier Mu\u00f1iz, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo Rodrigo 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Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariano","family":"Rivet","sequence":"additional","affiliation":[{"name":"Hospital General de Agudos Bernardino Rivadavia, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Paula","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviana Monica","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Sociedad Argentina de Infectolog\u00eda, Ciudad Aut\u00f3noma de Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Vilca Becerra","sequence":"additional","affiliation":[{"name":"Hospital Interzonal General de Agudos General San Mart\u00edn, La Plata, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula 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Core elements of hospital antibiotic stewardship programs | Antibiotic use. Available: https:\/\/www.cdc.gov\/antibiotic-use\/core-elements\/hospital.html#_ENREF_72 [Accessed 23 May 2021]."},{"key":"2025090412472197000_34.9.590.26","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000001245"},{"key":"2025090412472197000_34.9.590.27","unstructured":"Agency for Healthcare Research and Quality . Four moments of antibiotic decision making. 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