October 11, 2018
2 min read

WhatsApp alert improves real-time antimicrobial stewardship program

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SAN FRANCISCO — A hospital antimicrobial stewardship program in Mexico City incorporated a smartphone messaging app as a fundamental part of real-time surveillance, improving the appropriate use of antibiotics, decreasing bacterial resistance and saving money, according to study findings presented at IDWeek.

“This is, for us, an important tool because it allows us to reduce antimicrobial use and get better patterns and rates of resistance for each antimicrobial,” Alberto Diaz-Romero, MD, an infectious disease fellow at the National Cancer Institute in Mexico City, told Infectious Disease News.

Diaz-Romero and colleagues evaluated the clinical impact of a WhatsApp group alert named “Rational Use of Antimicrobials” at a secondary health care hospital in Mexico City — General Hospital Dr. Manuel Gea González. The group alert included preauthorization and prospective audit and feedback interventions, allowing for real-time evaluation and decision of the best treatment option within a set time period of 2 hours per patient. Once alerted about a drug request, an ID team could find and assess a patient before recommending or denying the treatment.

Diaz-Romero and colleagues collected related data over a 3-year period from 2015 to 2017, including daily antibiotic dose consumption, cost savings, nosocomial bacterial resistance patterns and overall mortality rates associated with nosocomial infections. Of the 34 monitored drugs, eight were restricted and could only be prescribed by the ID team: meropenem, ertapenem, vancomycin, linezolid, quinolones, clindamycin, colistin and piperacillin/tazobactam, plus amphotericin B and echinocandin antifungals.

WhatsApp alert 
WhatsApp is being used for a real-time antimicrobial surveillance program in Mexico City.
Source: Marley Ghizzone, Infectious Disease New

According to Diaz-Romero and colleagues, of the 8,004 interventions included in the study, only 7.7% (n = 636) went unanswered within the 2-hour period. Study findings showed that at least 25% of prescriptions from the surgery unit and ICU were restricted, meaning the ID team was unable to justify the prescription of about 1 out of every 4 drugs prescribed from these units, Diaz-Romero said. The most restricted antibiotics were piperacillin/tazobactam, clindamycin and quinolones.

During 2016, use of ertapenem increased, which the researchers said may be attributable to the initiation of an outpatient parenteral antimicrobial therapy program. According to the findings, costs associated with colistin and carbapenems declined $130,000 and $64,800, respectively, blood cultures of drug-resistant Pseudomonas aeruginosa and Acinobacter baumannii isolates associated with nosocomial infections decreased by 75% and the number of Clostridium difficile infections also decreased. Moreover, there was no observed increase in the overall mortality rate, the researchers reported.

“Antimicrobial stewardship can work for every country,” Diaz-Romero said. “We’ve found a way to perform this program easily through WhatsApp, and it’s working for us.” – by Marley Ghizzone


Diaz-Romero A, et al. Abstract 1783. Presented at: IDWeek; Oct. 3-7, 2018; San Francisco.

Disclosures: The authors report no relevant financial disclosures.