PMID- 37025495 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230411 IS - 1663-9812 (Print) IS - 1663-9812 (Electronic) IS - 1663-9812 (Linking) VI - 14 DP - 2023 TI - Building an antimicrobial stewardship program: A narrative of six years under the Donabedian perspective. PG - 1074389 LID - 10.3389/fphar.2023.1074389 [doi] LID - 1074389 AB - Introduction: Antimicrobial resistance (AMR) is increasing and represents one of the world's major challenges. AMR increase morbimortality, length of hospital stay and costs. Antimicrobial Stewardship Programs (ASP) are one of the key strategies to promote the rational use of antimicrobials since AMR is mostly driven by antimicrobial consumption. Objective: To describe the ASP implementation in a teaching hospital from the perspective of Donabedian quality assessment and the Brazilian regulatory requirements. Method: This was a descriptive study with secondary data collection, including document review of the ASP. The study setting was a general public 392-bed hospital. The ASP activities were performed by the hospital infection control committee (HICC), hospital pharmacy (HP) and diagnostic support laboratory (DSL). The description of the three services mainly involved in the ASP was based on a quality assessment model involving the dimensions of "structure", "process" and "result" proposed by Donabedian. The distribution among dimensions was guided by the checklist of essential elements of the ASP that compose the Brazilian regulatory requirements. The checklist was applied in July, 2022, and the ASP results described from 2016 to 2021. Results: ASP actions have been gradually implemented since 2008 with the implementation of HICC and improved over the years. Regarding structure, the investments in technology were mapped, quantifying 26 computers and three software programs employed to computerize the ASP processes performed in specific physical areas by HICC, HP and DSL. Institutional guidelines used by HICC, HP and DSL guided clinical practices to operationalize ASP. The evaluation metrics improved for 10 indicators and worsened for four indicators. From the 60 items composing the checklist, the hospital met the requirements in 73.3% of the items (n = 44). Conclusion: This study described the implementation of ASP in a teaching hospital, applying the Donabedian perspective. Although the hospital still does not have a classic ASP model, there were investments to improve structure, processes and results, aiming to comply with international guidelines. A high proportion of key elements of ASP in the hospital were followed according to the Brazilian regulatory requirements. Aspects related to antimicrobial consumption and the emergence of microbial resistance deserve further investigations. CI - Copyright (c) 2023 Fonseca Medeiros, Margotto Bertollo, Moreira Reis, Costa, Meireles Leite, da Silva Goncalves, Nogueira Guimaraes de Abreu, Pedra de Souza and Parreiras Martins. FAU - Fonseca Medeiros, Amanda AU - Fonseca Medeiros A AD - Faculdade de Farmacia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. AD - Hospital Risoleta Tolentino Neves, Rua das Gabirobas, Belo Horizonte, Minas Gerais, Brazil. FAU - Margotto Bertollo, Caryne AU - Margotto Bertollo C AD - Faculdade de Farmacia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. AD - Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. FAU - Moreira Reis, Adriano Max AU - Moreira Reis AM AD - Faculdade de Farmacia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. AD - Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. FAU - Costa, Monica Aparecida AU - Costa MA AD - Hospital Risoleta Tolentino Neves, Rua das Gabirobas, Belo Horizonte, Minas Gerais, Brazil. FAU - Meireles Leite, Edna Marilea AU - Meireles Leite EM AD - Hospital Risoleta Tolentino Neves, Rua das Gabirobas, Belo Horizonte, Minas Gerais, Brazil. FAU - da Silva Goncalves, Simony AU - da Silva Goncalves S AD - Hospital Risoleta Tolentino Neves, Rua das Gabirobas, Belo Horizonte, Minas Gerais, Brazil. FAU - Nogueira Guimaraes de Abreu, Mauro Henrique AU - Nogueira Guimaraes de Abreu MH AD - Faculdade de Odontologia da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. FAU - Pedra de Souza, Renan AU - Pedra de Souza R AD - Departamento de Genetica, Ecologia e Evolucao, Instituto de Ciencias Biologicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. FAU - Parreiras Martins, Maria Auxiliadora AU - Parreiras Martins MA AD - Faculdade de Farmacia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. AD - Hospital Risoleta Tolentino Neves, Rua das Gabirobas, Belo Horizonte, Minas Gerais, Brazil. AD - Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. AD - Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. LA - eng PT - Journal Article DEP - 20230321 PL - Switzerland TA - Front Pharmacol JT - Frontiers in pharmacology JID - 101548923 PMC - PMC10070795 OTO - NOTNLM OT - Antimicrobial Stewardship OT - drug resistance microbial OT - outcome and process assessment, health care OT - outcome assessment health care OT - pharmacoepidemiology OT - quality assurance, health care COIS- The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2023/04/08 06:00 MHDA- 2023/04/08 06:01 PMCR- 2023/03/21 CRDT- 2023/04/07 02:30 PHST- 2022/10/19 00:00 [received] PHST- 2023/02/28 00:00 [accepted] PHST- 2023/04/08 06:01 [medline] PHST- 2023/04/07 02:30 [entrez] PHST- 2023/04/08 06:00 [pubmed] PHST- 2023/03/21 00:00 [pmc-release] AID - 1074389 [pii] AID - 10.3389/fphar.2023.1074389 [doi] PST - epublish SO - Front Pharmacol. 2023 Mar 21;14:1074389. doi: 10.3389/fphar.2023.1074389. eCollection 2023.