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OBJECTIVE: To assess the impact of antimicrobial stewardship programs (ASPs) in adult medical-surgical intensive care units (MS-ICUs) in Latin America. DESIGN: Quasi-experimental prospective with continuous time series. SETTING: The study included 77 MS-ICUs in 9 Latin American countries. PATIENTS: Adult patients admitted to an MS-ICU for at least 24 hours were included in the study. METHODS: This multicenter study was conducted over 12 months. To evaluate the ASPs, representatives from all MS-ICUs performed a self-assessment survey (0-100 scale) at the beginning and end of the study. The impact of each ASP was evaluated monthly using the following measures: antimicrobial consumption, appropriateness of antimicrobial treatments, crude mortality, and multidrug-resistant microorganisms in healthcare-associated infections (MDRO-HAIs). Using final stewardship program quality self-assessment scores, MS-ICUs were stratified and compared among 3 groups: ≤25th percentile, >25th to <75th percentile, and ≥75th percentile. RESULTS: In total, 77 MS-ICU from 9 Latin American countries completed the study. Twenty MS-ICUs reached at least the 75th percentile at the end of the study in comparison with the same number who remain within the 25th percentile (score, 76.1 ± 7.5 vs 28.0 ± 7.3; P < .0001). Several indicators performed better in the MS-ICUs in the 75th versus 25th percentiles: antimicrobial consumption (143.4 vs 159.4 DDD per 100 patient days; P < .0001), adherence to clinical guidelines (92.5% vs 59.3%; P < .0001), validation of prescription by pharmacist (72.0% vs 58.0%; P < .0001), crude mortality (15.9% vs 17.7%; P < .0001), and MDRO-HAIs (9.45 vs 10.96 cases per 1,000 patient days; P = .004). CONCLUSION: MS-ICUs with more comprehensive ASPs showed significant improvement in antimicrobial utilization.

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El presente es el reporte de un caso de un paciente masculino de 37 años, con manifestaciones clínicas de aproximadamente 1 año de evolución caracterizadas por cefalea holocraneana de gran intensidad, fotofobia, diplopía, que se exacerban en los últimos tres meses con alucinaciones, pérdida de audición de oído izquierdo, refirió exposición de 4 años a heces de aves (palomas) por su trabajo en el puerto marítimo.Acudió por consulta privada a valoración y manejo, se le efectúa el diagnóstico de diabetes mellitus tipo 2, por lo cual se prescribió metformina oral, una vez iniciado el tratamiento presentó exacerbación de los síntomas neurológicos, por lo que se indicó internación hospitalaria y se sometió a investigación para diagnóstico de su enfermedad, con presunción de meningitis bacteriana, se le realizó punción lumbar para estudios microbiológicos y se inició tratamiento empírico con glucopeptido y carbapenemico. Con el esquema antimicrobiano presentó leve mejoría en la intensidad de sus síntomas, en el estudio microbiológico del líquido cefalorraquídeo se observaron estructuras micóticas compatibles con Cryptococcus, por lo cual se realizó una segunda punción lumbar para conseguir una muestra adecuada para cultivo y estudio con biología molecular, a fin de establecer el diagnóstico definitivo del microorganismo.

The present is a report of a 37-year-old male patient, who present clinical manifestations of approximately 1 year, by high-intensity holocranial headache, photophobia, diplopia, which were exacerbated in the last three months with hallucinations, loss of Hearing from the left ear, hereported exposure of 4 years to feces of birds (pigeons) for his work in the seaport.The patient was refer to a private consultation to assessment and management, he was diagnosed with type 2 diabetes mellitus, for which oral metformin was prescribed, once the treatment had begun, exacerbation of the neurological symptoms, so hospitalization was indicated, and He underwent research to diagnose his disease, with presumed bacterial meningitis, he underwent lumbar puncture for microbiological studies and began empirical treatment with glucopeptide and carbapenemic; With the antimicrobial scheme, there was a slight improvement in the intensity of its symptoms. In the microbiological study of the preliminary cerebrospinal fluid, fungal structures compatible with Cryptococcus were observe; a second lumbar puncture was performed to obtain an adequate sample for culture and study with molecular biology, in order to establish the definitive diagnosis of the microorganism.

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