2dbf8d3d22727f87803b4ffd234fa8d1 pmc_11505327.pdf 02ef418df98c40c0372ccc113b98bbb0e73b927f pmc_11505327.pdf fc1bbc275de002fde4fbdb877f67966466fe83ab735397deea381d2a349e0c1f pmc_11505327.pdf Title: Trends in Antimicrobial Consumption in Tertiary Care Hospitals in Costa Rica from 2017 to 2021: A Comparative Analysis of Defined Daily Doses per 100 Bed Days and per 100 Discharges Subject: Background: Antimicrobial consumption (AMC) data in Latin America are scarce and usually spread out across different sources used to make AMC calculations, making it difficult to both standardize and compare regions through similar time frames. The main objective was to analyze AMC trends in Social Security tertiary care hospitals in Costa Rica in the period spanning January 2017 to December 2021, using both the defined daily dose (DDD)/100 bed days and DDD/100 discharges. Methods: This is a retrospective observational study of antimicrobial consumption. Global consumption trends were calculated and expressed as DDD/100 bed days and DDD/100 discharges. Trends in antimicrobial consumption were analyzed using a simple linear regression model to determine potential differences in antimicrobial usage throughout the study’s duration. Results: A statistically significant increase in the consumption expressed in DDD/100 discharges was observed in the following groups: carbapenems, 7.6% (trend: 64.68, p < 0.0001), trimethoprim-sulfamethoxazole: 12.6% (trend: 16.45, p < 0.0001), quinolones 9.4% (trend: 36.80, p = 0.02), vancomycin 2.0% (trend: 16.30, p = 0.03), echinocandins: 6.0% (trend: 15.17, p = 0.01) and azole antifungals: 12.10% (trend: 102.05, p < 0.0001). Additionally, a statistically significant increase of 10.30% in the consumption of azole antifungals expressed in DDD/100 bed days was observed (p = 0.0008). In contrast, a statistically significant decrease in consumption, expressed in DDD/100 discharges, was identified for cephalosporins -6.0% (p < 0.0001) and macrolides -16.5% (p < 0.0001). Macrolides also showed a downward trend in consumption, as expressed in DDD/100 bed days (-14.3%, p < 0.0001). According to World Health Organization (WHO) access, watch and reserve (AWaRe) classification trend analysis, only the reserve group showed a statistically significant upward change of 9.2% (p = 0.016). Conclusions: This five-year analysis demonstrated trends over time in overall antimicrobial consumption measured in DDD/100 bed days and DDD/100 discharge rates that correlate. In general, for all antimicrobials, after the implementation of antimicrobial stewardship programs (ASP), a downward trend is reported; in contrast, during the COVID-19 pandemic the AMC shows a general upward trend. The comparison between DDD/100 bed days and DDD/100 discharges allows for complementary comparisons to be made regarding antimicrobial exposure in a clinical setting. Keywords: antimicrobial consumption; antimicrobial stewardship; defined daily dose Author: Cristina Fernández-Barrantes, Allan Ramos-Esquivel, Luis Esteban Hernández-Soto, Manuel Ramírez-Cardoce, Luis David Garro-Zamora, Jose Castro Cordero and Santiago Grau Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Sun Oct 6 16:59:49 2024 CEST ModDate: Sun Oct 6 17:09:56 2024 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 17 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 2655779 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- SSNIUI+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 WIOURY+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 EKFKXW+URWPalladioL-Roma Type 1 Custom yes yes yes 22 0 ASJLVW+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 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yes no 159 0 MJOHCP+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 162 0 MJOHDA+PalatinoLinotype CID TrueType Identity-H yes yes yes 165 0 MJOHDB+PalatinoLinotype TrueType WinAnsi yes yes no 171 0 MJOHDD+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 174 0 MJOHID+PalatinoLinotype TrueType MacRoman yes yes no 177 0 MJOHCO+PalatinoLinotype,Bold CID TrueType Identity-H yes yes yes 194 0 MJOICD+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 200 0 MJOHCP+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 203 0 MJOHDA+PalatinoLinotype CID TrueType Identity-H yes yes yes 206 0 MJOHDB+PalatinoLinotype TrueType WinAnsi yes yes no 212 0 MJOHDD+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 215 0 MJOHID+PalatinoLinotype TrueType MacRoman yes yes no 218 0 WABLSD+SFRM1000 Type 1 Custom yes yes yes 225 0 MJOHCP+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 251 0 MJOHDA+PalatinoLinotype CID TrueType Identity-H yes yes yes 254 0 MJOHDB+PalatinoLinotype TrueType WinAnsi yes yes no 260 0 MJOHDC+PalatinoLinotype,Italic CID TrueType Identity-H yes yes yes 263 0 MJOHDD+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 269 0 MJOHID+PalatinoLinotype TrueType MacRoman yes yes no 272 0 YLKJXZ+VnURWPalladioL-Italic Type 1 Custom yes yes yes 285 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-02-06 02:46:59 CET RepresentationInformation: pmc_11505327.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-12-04 02:21:32 CET Size: 2655779 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 451 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Results Destination: section.2 Children: Item: Title: Indicators of Hospital Activity Destination: subsection.2.1 Item: Title: Antimicrobial Consumption Patterns and Trends in the Period 2017 2021 Destination: subsection.2.2 Item: Title: Discussion Destination: section.3 Item: Title: Materials and Methods Destination: section.4 Children: Item: Title: Setting and Study Design Destination: subsection.4.1 Item: Title: Data Collection Destination: subsection.4.2 Item: Title: Statistics Analysis Destination: subsection.4.3 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.6 Info: Title: Trends in Antimicrobial Consumption in Tertiary Care Hospitals in Costa Rica from 2017 to 2021: A Comparative Analysis of Defined Daily Doses per 100 Bed Days and per 100 Discharges Author: Cristina Fernández-Barrantes, Allan Ramos-Esquivel, Luis Esteban Hernández-Soto, Manuel Ramírez-Cardoce, Luis David Garro-Zamora, Jose Castro Cordero and Santiago Grau Subject: Background: Antimicrobial consumption (AMC) data in Latin America are scarce and usually spread out across different sources used to make AMC calculations, making it difficult to both standardize and compare regions through similar time frames. The main objective was to analyze AMC trends in Social Security tertiary care hospitals in Costa Rica in the period spanning January 2017 to December 2021, using both the defined daily dose (DDD)/100 bed days and DDD/100 discharges. Methods: This is a retrospective observational study of antimicrobial consumption. Global consumption trends were calculated and expressed as DDD/100 bed days and DDD/100 discharges. Trends in antimicrobial consumption were analyzed using a simple linear regression model to determine potential differences in antimicrobial usage throughout the study’s duration. Results: A statistically significant increase in the consumption expressed in DDD/100 discharges was observed in the following groups: carbapenems, 7.6% (trend: 64.68, p < 0.0001), trimethoprim-sulfamethoxazole: 12.6% (trend: 16.45, p < 0.0001), quinolones 9.4% (trend: 36.80, p = 0.02), vancomycin 2.0% (trend: 16.30, p = 0.03), echinocandins: 6.0% (trend: 15.17, p = 0.01) and azole antifungals: 12.10% (trend: 102.05, p < 0.0001). Additionally, a statistically significant increase of 10.30% in the consumption of azole antifungals expressed in DDD/100 bed days was observed (p = 0.0008). In contrast, a statistically significant decrease in consumption, expressed in DDD/100 discharges, was identified for cephalosporins -6.0% (p < 0.0001) and macrolides -16.5% (p < 0.0001). Macrolides also showed a downward trend in consumption, as expressed in DDD/100 bed days (-14.3%, p < 0.0001). According to World Health Organization (WHO) access, watch and reserve (AWaRe) classification trend analysis, only the reserve group showed a statistically significant upward change of 9.2% (p = 0.016). Conclusions: This five-year analysis demonstrated trends over time in overall antimicrobial consumption measured in DDD/100 bed days and DDD/100 discharge rates that correlate. In general, for all antimicrobials, after the implementation of antimicrobial stewardship programs (ASP), a downward trend is reported; in contrast, during the COVID-19 pandemic the AMC shows a general upward trend. The comparison between DDD/100 bed days and DDD/100 discharges allows for complementary comparisons to be made regarding antimicrobial exposure in a clinical setting. 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