Prevalence and risk factors associated with SARS-CoV-2 infection among workers of Instituto Nacional de Salud del Nino, Peru, April 2020 to March 2021.

Objective: To determine the prevalence and risk factors associated with SARS-CoV-2 infection among workers of Instituto Nacional de Salud del Nino (INSN) from April 2020 to March 2021. Material(s) and Method(s): A non-experimental, descriptive, cross-sectional study. The sample consisted of 608 workers who tested positive for COVID-19 using a rapid antigen test. The COVID-19 clinical-epidemiological research sheets prepared by the Ministry of Health of Peru and self-administered by the workers were reviewed. The INSN Department of Epidemiology staff verified the completion of the sheets. The data was entered into a database, which was used for the respective statistical analysis. The study was approved by the INSN Institutional Research Ethics Committee (registration code: PI-17/21). Result(s): COVID-19 prevalence among INSN workers was 7.24 % from April 2020 to March 2021. Out of the workers with COVID-19, 71.4 % were women;83.4 % were in the 30 to 59 age range with an average age of 44.71 years;65.6 % were healthcare workers, most of whom were nursing technicians;and 56.9 % experienced symptoms, mainly fever/chills (12.2 %), cough (8.9 %), malaise (7.7 %), sore throat (6.7 %), stuffy nose (2.5 %) and headache (1.3 %). Most workers lived in Lima Centro districts (33.2 %). A significant association between sex, age groups, worker type and worker profile was found. Conclusion(s): COVID-19 prevalence among INSN workers was 7.24 %;the most frequent characteristics, which showed significant differences with the rest of the factors, were being a woman, healthcare worker and nursing technician. A total of 56.9 % of the workers experienced symptoms, only 20.9 % developed clinical signs and 10.9 % had comorbidities.Copyright © La revista. Publicado por la Universidad de San Martin de Porres, Peru.

Saliva effect on RT-PCR performance

The use of saliva directly in RT-PCR reactions may be interesting, particularly in screenings for the detection of DNA/RNA of pathogens, due to the advantages of time and costs. However, its use faces some difficulties that essentially result from the saliva being a matrix with a variable composition and which contains inhibitors of the polymerization reaction. Saliva samples obtained from healthy donors were spiked with SARS-CoV-2 RNA and 3 viral targets were detected by RT-PCR. This work was considered exempt from review by an institutional ethical review board, because it comprises use of completely anonymized specimens obtained voluntarily and informed. The efficiency of RT-PCR reactions was calculated in the presence of variable amounts of saliva and the effect of saliva pre-treatment on the performance of each reaction was also analysed. It was found that saliva has no significant influence on the mean efficiency of each individual reaction, affecting mainly the beginning of the exponential phase of amplification, resulting in a significant increase in Ct values. This effect which is target dependent, presents a highly between-person variability (DELTACt = 0.93 to 11.36) and affects RNA/DNA detection and the limit-of-detection, but can be partly reversed by a treatment of saliva prior to the reaction. The work presented contributes to a better understanding of the advantages and limitations of using saliva directly in RT-PCR. This work was supported by ProjectNORTE-01-0145- FEDER-072545- SAICTCOVID/72545/2020 and was the result of the projects: UIDB/05937/2020 and UIDP/05937/2020- Centre for Research and Development in Agrifood Systems and Sustainability-funded by national funds, through FCT-Fundacao para a Ciencia e a Tecnologia.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.

Lymphocytic exhaustion in Covid-19 patients

Introduction: The persistence of the SARS-CoV-2 virus is related to inflammation and lymphopenia in severe Covid19. Longitudinal follow-up of patients is scarce and would be of help to determine if the different immune responses lead to different clinical presentations Methods: Longitudinal prospective observational study of 91 patients. They were classified into viral phase, early inflammatory, and late inflammatory. We included clinical data, immune cell count, proinflammatory cytokine levels, serum inflammatory markers and tissue damage. Result(s): Lymphocyte count was lower with greater severity, and double in survivors. It remained stable during evolution, but with variations depending on the level of severity: critical and deceased patients, had a very low initial count (500/mm3) that did not increase;severe patients the initial lymphopenia (900/mm3) normalized during hospitalization;and moderate, showed a normal and stable count. The correlation of the initial innate immune response cytokine TNF-a with the T-cell-derived (CD4+) cytokines, IFN-g and IL-17A, was significant at all severity levels, although this correlation decreased in the late inflammatory phase. Furthermore, in patients who reached critical status or died, there was not the sustained increase in IFN-g levels observed in less severe Covid-19 (p<0.001), coinciding with the persistent lymphopenia in those patients. Conclusion(s): Our results confirm a drop in lymphocyte counts and decreased production of effector T-cell cytokines in the most severe patients, especially in the late phase of evolution, in line with the lymphocyte depletion described in critical and fatal Covid-19 disease.

Evolution ofIL-6 as possible marker of viral control in Covid-19

Introduction: Persistence of SARS-Cov-2 leads to immunosuppression and lack of viral control. Better understanding of the immune response throughout the course of evolution is important for a better patient management. Method(s): Prospective observational longitudinal study of 91 hospitalised patients with different degrees of severity (moderate, severe, critical). In 72 we obtained >=2 blood samples and classified them into viral phase (1-9 days after clinical onset), early inflammatory (10-16), and late inflammatory (>17). We included clinical data, immune cell counts, proinflammatory cytokine levels, serum inflammatory markers, and tissue damage. Result(s): We observed higher serum IL-6 levels in the more severe groups, from the first sample. In inflammatory phases, we found a significant decrease in IL-6 and LDH in moderate, severe and survivors, and high persistence in critical and deceased patients. The biphasic behavior of IL-6 described, first neutrophil recruitment, epithelial and endothelial damage and then, after achieving viral control, CD4 differentiation, Th cells response and potentiation of Ac response, could explain these differences between those who do not achieve viral control (critical, deceased) and those who do. Conclusion(s): - IL-6 levels at 10-16 days may indicate whether or not viral control is achieved and whether there may be progression to critical stage/death.

Covid-19 and NETs

Introduction: Neutrophil extracellular traps (NETs) have recently been linked to an important role in the pathogenesis of Covid-19. Method(s): Prospective observational study of 91 hospitalized patients. We studied longitudinally the viral phase, early inflammatory and late, and the 4 most specific components of NETs: cell free-DNA (cfDNA), MPO-DNA and NE-DNA complexes and citrullinated Histone 3 (citH3). Result(s): We observed elevated levels vs controls of MPO-DNA and NE-DNA complexes and cfDNA at admission and in the 3 phases of the disease. CitH3 was elevated from the early inflammatory phase onwards. There was a significant correlation in survivors (r=0.798) and in all severity degrees between MPO and NE and between cfDNA and H3 cit (r=0.3), but not in the rest of combinations among the 4, nor in dead patients. We did not observe any correlation in any group between MPO or NE with citH3. There was an increase of only cfDNA levels in more severe patients. The area under the ROC curve for critical severity and mortality was high for cfDNA (0.7327 and 0.7482) and much poorer for the other 3 NETs markers. Conclusion(s): -We found evidence of neutrophil activation of NETs components in Covid-19, during the 3 phases of the disease, but without a clear relationship with severity and mortality. -cfDNA was related to severity and mortality, and its sources appeared to be more related to tissue damage than to NETs -The best correlation between them was MPO-NE, and these more neutrophil-specific markers reflect probably better NET formation. NETs role has maybe been overestimated using other less specific markers.

Analysis of brain metabolism using FDG-PET/CT in patients with acute Covid-19

Aim/Introduction: Neurological sequelae of Covid-19 have been widely documented by anatomic and functional methods [1,2]. Brain metabolism studies using 18F-FDG PET/CT during the subacute phase of the disease have also been published [1]. On the other hand, there is a lack of information about the influence of SARS-Cov2 infection on brain metabolism during the acute phase of the disease. The aim of this study was to identify and quantify changes in brain metabolism during the acute onset of Covid-19. Material(s) and Method(s): We studied 23 patients (13 women, median age 55.5[33-78] years) hospitalized with positive nasopharyngeal swab test (RT-PCR) for Covid-19 and requiring supplemental oxygen. Dedicated PET/CT images of the brain were acquired for 10 minutes, 1h after injection of 4.4 MBq/kg of 18F-FDG. Visual analysis was performed by two nuclear medicine specialists and one radiologist. Quantitative analysis was performed using dedicated software. 18F-FDG uptake in multiple brain regions was evaluated and the standard deviation (SD) of brain uptake in each region was automatically calculated in comparison with a group of normal subjects. More than 2 SD above or below the control group was considered significant in each area. Result(s): Serum C-reactive protein at admission ranged from 6.43 to 189.0 mg/L (mean 97.0 +/- 55.5 mg/L). The mean supplemental oxygen demand was 2.8 +/- 1.5 L/min. PET/CT images were acquired between 4 and 20 days of symptoms (mean 12.9 +/- 3.8 days). The images showed increased glycolytic metabolism in basal ganglia and relatively reduced brain metabolism in cortical regions. Basal ganglia metabolism was bilaterally increased in 18/23 (78.3%) and normal in 5 (21.7%) patients. Lenticular nucleus presented increased metabolism in 21/23 (91.3%) and was normal in 2 (8.7%) patients. Frontal and parietal lobes metabolism was respectively reduced in 9/24 (37.6%) and 8/23 (34.8%) patients. The whole brain metabolism was normal in 20/23 (86.9%) patients. Olfactory cortex metabolism was normal in 18/23 (78.3%) patients. Conclusion(s): Brain metabolism is clearly affected during the acute phase of SARS-Cov2 infection. The most frequent finding was increased basal ganglia metabolism, with most patients presenting marked lenticular nucleus hypermetabolism. Frontal and parietal lobes presented reduced metabolism in some patients. Interestingly, olfactory cortex is not affected in most patients, suggesting that anosmia, reported by some patients, is not related to the direct involvement of the brain by the disease.

Systemic Amyloid Light Chain (AL) Amyloidosis Patient Experience Research

Background: There is limited empirical evidence exploring the patient experience and treatment needs in AL-amyloidosis. Many patients experience delays in receiving a diagnosis and research suggests they suffer from a lack of support and information about the condition, worsening the impact of the disease on their quality-of-life. In June 2021 the EMA granted marketing authorisation for daratumumab in combination with bortezomib, cyclophosphamide and dexamethasone (DBCd) to treat adults with newly diagnosed AL-amyloidosis. Previously, patients have been treated with off-label therapies for multiple myeloma. Objective(s): To develop greater understanding of the diagnosis, management of the disease, and impact on patients and carers, in the UK. Method(s): A literature review and focus groups with adults living with AL-amyloidosis and a carer. Group 1 consisted of 3 adults, group 2 of 3 adults plus 1 carer. Groups were semi-structured;discussion topics included the patient journey, impact of disease, and COVID-19. Result(s): Despite delays to diagnosis, ongoing relationships with consultants fostered good communication with patients. In the treatment pathway, patients prioritised extension of life and quality-of-life, even if side-effects from treatment impaired quality-of-life. Participants spoke highly of their healthcare teams and experiences with the National Amyloidosis Centre. Impacts on daily life and emotional well-being tended to be more prominent among patients with a more complex disease pathway. For patients, time to diagnosis, ongoing communication with a trustworthy consultant, treatment outcomes and support was important. Although generally satisfied, suggestions for change across the diagnostic and treatment pathway were recommended. Striving for consistency of care and communication was paramount, and treatment impacts on day-to-day life (e.g., through minimising side-effects and convenient administration) should be prioritised. Conclusion(s): Results have the power to better inform healthcare decisions and the development of specific treatments, prioritising interventions that align with the unmet needs and preferences of people living with AL-amyloidosis. Copyright © 2022

MDMA-Assisted Therapy for Treatment-Resistant Posttraumatic Stress Disorder (PTSD) - One step further toward a patient-centered treatment pathway

Introduction: PTSD is a chronic, debilitating condition with limited treatment efficacy. Accessing traumatic memories often leads to overwhelming distress, impacting treatment process. Current approved pharmacological treatments have exhibited small to moderate effects when compared with placebo. Evidence suggests 3,4,-methylene-dioxymethamphetamine(MDMA)-assisted psychotherapy as a viable option for refractory PTSD. Objective(s): Comprehensive review of early clinical research, proposed mechanisms, safety and emerging therapeutic models. Method(s): Eligible studies will be identified through strategic search of MEDLINE. Result(s): Pre-clinical and imaging studies suggest memory reconsolidation and fear extinction as candidate psychological and neurological mechanisms, involving MDMA's combined effects of increasing serotonergic activity, as well the release of oxytocin and brain-derived neurotrophic factor in key memory and emotional circuits. Resulting reduction in amygdala and insula activation and increasing connectivity between the amygdala and hippocampus may create a tolerance window of neuroplasticity for emotional engagement and reprocessing of traumatic memories during psychotherapy. Early clinical trials report impressive and durable reduction in PTSD symptoms, with a safety profile comparable to that of SSRIs. A recently completed randomized, double-blind, placebocontrolled phase 3 trial reported full remission of PTSD symptoms in 67% of patients at 2 months, with no increase in suicidality, cardiovascular events or abuse behavior. Emerging treatment models underline the importance of unmedicated therapeutic sessions for preparation for the experience and subsequent integration as essential for full benefit and safety of the clinical context. Conclusion(s): The psychological impact associated with the COVID-19 pandemic is an reminder of the emotional and economic burden associated with PTSD. MDMA-assisted therapy may be a breakthrough approach meriting further multidisciplinary investment and clinical research.

Clinical Practice Guideline for the treatment of COVID-19 in the Social Security of Peru (EsSalud)

Introduction: Since the beginning of the COVID-19 pandemic, different drugs and medications have been used for the prevention and treatment of COVID-19 infection. Likewise, various investigations have been carried out to evaluate the efficacy and safety of these interventions, many of which have been shown to generate more harm than benefit for the patient, for this reason it is necessary to standardize the management of adult patients with COVID-19 in our context. Objective: To provide evidence-based clinical recommendations for the management of adults with COVID-19. Methods: A guideline development group (GEG) was formed that included medical specialists and methodologists. For its elaboration, GEG decided to carry out a rapid adaptation of the Guide for the care of critical adult patients with COVID-19 in the Americas of the Pan American Health Organization (PAHO) as well as to carry out searches for novo questions. For the formulation of the recommendations, the evidence frameworks for the decision (EtD) of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology were developed. Results: This CPG addressed 28 clinical questions, divided into three topics: prevention, diagnosis and management. Based on these questions, 33 recommendations (16 strong and 17 conditional), 26 good clinical practices (GCP) and 2 flowcharts were formulated. This CPG was published in its third version in December 2021 Conclusion: This article summarizes the methodology and evidence-based conclusions of the CPG for the management of adults with COVID 19 in EsSalud. © 2022 Publicado por Cuerpo Médico Hospital Nacional Almanzor Aguinaga Asenjo.

Predicted impact of an emergency department influenza vaccine program

Study Objective: Seasonal influenza is associated with significant healthcare resource utilization. An estimated 490,000 hospitalizations and 34,000 deaths were attributed to influenza during the 2018 - 2019 season. Despite robust influenza vaccination programs in both the inpatient and outpatient setting, the emergency department (ED) represents a missed opportunity to vaccinate patients at high risk for influenza who do not have access to routine preventive care. Feasibility and implementation of ED-based influenza vaccination programs have been previously described but have stopped short of describing the predicted health resource impact. The goal of our study was to describe the potential impact of an influenza vaccination program in an urban adult emergency department population using historic patient data.

Approaches to education policies on the global scene of the post-COVID 19 pandemic

The COVID 19 pandemic had an unusual multidimensional impact on humanity as a whole, creating or recreating new or renewed forms of relationship between people, communities and the state, as an articulating entity of social relations and spaces of human development. In this context, the general use of ICTs in teaching-learning processes at all levels of the educational system is common, to the detriment of the person-to-person encounter affected by social distancing. The objective of the article is to describe a useful conceptual framework to redefine educational policies in accordance with the new realities that characterize post-pandemic scenarios in Ecuador. Methodologically it is a documentary, analytical and prospective research. The authors conclude that investment in education is considered urgent since its material and symbolic spaces mean for the majority of young people the most legitimate opportunity to train, achieve better opportunities and ascend socially, a situation that reduces the dynamics of social conflict.

PREDICTING FACTORS OF PROLONGED MECHANICAL VENTILATION AFTER ENDOVASCULAR TREATMENT IN LARGE VESSEL OCCLUSION STROKE

Background and aims: Intensive Care Units(ICUs) are a necessary resource for many patients with large vessel occlusion stroke(LVOS) after endovascular treatment(EVT). However, ICUs have a limited availability of beds and ventilators, situation that has been worsened by the current Covid-19 pandemic. We analyze predicting factors for prolonged mechanical ventilation(PMV) after EVT in patients with LVOS. Methods: Retrospective study of patients admitted to our stroke center from 2012-2019 for LVOS who were treated with EVT. We identified patients that required PMV(defined as >24h intubation with admission in ICU) after EVT, and evaluated the association with clinical and radiological factors on admission. Results: N=438. 236(53.9%) women. Mean age 69(DE 14.6). 411(93.8%) anterior circulation stroke, 27(6.2%) posterior. 82(19%) required general anesthesia and intraprocedural intubation, and 47 of them(10.7%) required PMV. Median length of stay(LOS) in ICU: 3 days(1-7). 12/47(25.5%) had prolonged LOS for another reason (6 neurological worsening, 4 hemodynamic instability, 1 respiratory infection, 1 no available beds at Stroke Unit). 19/47(44%) died and 22/47(52.4%) were functionally dependent at three months. Factors associated to a higher risk of PMV after EVT were: basilar occlusion (OR=12.3, IC95%[5.3-28.4],p<0,001);ASPECTS ≤7 (OR=3, IC95%[1.4-6.1],p=0,003) and NIHSS ≥18 (OR=2.8, IC95%[1.3- 5.8],p=0,006). Patients with PMV had a higher risk of mortality (OR=6.5, IC95%[3.3-12.8],p<0,001) and functional dependence (OR=5.1, IC95%[2.4-1],p<0,001) at three months. Conclusions: In our study, patients with basilar occlusion, high NIHSS and lower ASPECTS had higher probability of requiring PMV after EVT, which also led to worse outcome. These are aspects to consider in scenarios with limited availability of ICU beds.

Contextualizing Types of Filipino Collective Support during the #COVID19 Lockdown

The lockdown as a countermeasure at the onset of the COVID-19 pandemic gained diverse responses globally. Many turned to Social Media platforms such as Twitter to express their sentiments on health crisis-related concerns. This study magnified the collective support-related Twitter content posted by users within the Philippines at the beginning of the pandemic. Collective Support expressions were collected using the Twitter Python Library and examined using content analysis. The primary goal is to elicit insights to understand the Filipinos' social/collective behaviors and how they were manifested at the onset of the COVID-19 lockdown. Hofstede's and Triandis' Theory of Collectivism primarily guided the direction of the study towards the affirmation of the Philippines as a collectivistic nation as demonstrated in the Collective Support Tweets classified under the following identified themes: (1) Language of Appreciation, Tribute, Support, covering the most significant percentage with 38.96% of the collective support tweets;(2) Friendly Reminders with 28.91%;(3) Acts of Community Service comprising 20.31%;and (4) Encouraging Words forming 11.82%. Given the Filipino's traditional familial and community-oriented culture, their collectivistic behavior shall naturally be conveyed irrespective of location, technology, and other relevant settings. However, considering the Twitter dataset under study, the technology shaped cultural implications based on the shared Twitter content in the Philippines. Further, it has affirmed the Philippines' collectivistic culture in accordance with the indicators under Hofstede's and Triandis' Theory of Collectivism.

Home delivery and telepharmacy programme: satisfaction of patients

Background and importanceThe SARS-CoV-2 pandemic has generated new needs in outpatient care of the hospital pharmacy. Despite the current improvement in the pandemic situation, many of the implemented progress have been maintained. Telepharmacy and home delivery programmes avoid hospital visits for vulnerable patients (elderly, pluripathology, mobility problems).Aim and objectivesTo analyse the degree of satisfaction of patients included in a telepharmacy and home delivery programme.Material and methodsDescriptive retrospective study of patients included in a telepharmacy and home delivery programme between November 2020 and September 2021 was conducted. Electronic clinical history and prescription software Farmatools were used to record data: sex, age, pathology, locality, transport conditions of the medication and number of shipments per patient. A telephone survey was conducted, consisting of four questions about: satisfaction with telepharmacy programme (yes/no), adequate pharmaceutical telephone support (yes/no), medication delivery conditions (correct/incorrect) and global assessment (ranged 1–10). Comments and suggestions were also requested.ResultsFifty-six patients were included, 35 (63%) were women and 21 (37%) men. Mean age was 65 (37–90) years. The pathologies involved were: 11 (20%) infectious diseases, 10 (18%) respiratory, 9 (16%) rheumatic, 8 (14%) neurological, 7 (12%) renal, 5 (9%) haematological, 3 (5%) ophthalmological, 2 (4%) digestive and 1 (2%) allergic. A total of 456 medication shipments were delivered during the study period, with a mean of 8 (2–24) per patient. The shipments were distributed among 31 different localities in the same health area. The medication for 27 (48%) patients required refrigerated transport, and 29 (52%) required ambient temperature. All (100%) patients were satisfied with telepharmacy programme and reported an adequate pharmaceutical telephone support. Medication delivery conditions were considered correct to 54 (96%) patients and incorrect to 2 (4%). Mean global assessment score was 9.6 (8–10). Four (7%) patients suggested an improvement in delivery conditions.Conclusion and relevanceThe survey results indicated a high degree of satisfaction of the patients included in the telepharmacy and home delivery programme. Although this system of pharmaceutical care and distribution of medicines was implemented because of the pandemic, its subsequent maintenance has allowed vulnerable patients to benefit. Further measures could be implemented to improve delivery conditions.References and/or acknowledgementsConflict of interestNo conflict of interest

Developing and validating high-value patient digital follow-up services: a pilot study in cardiac surgery.

BACKGROUND: The existing digital healthcare solutions demand a service development approach that assesses needs, experience, and outcomes, to develop high-value digital healthcare services. The objective of this study was to develop a digital transformation of the patients' follow-up service after cardiac surgery, based on a remote patient monitoring service that would respond to the real context challenges. METHODS: The study followed the Design Science Research methodology framework and incorporated concepts from the Lean startup method to start designing a minimal viable product (MVP) from the available resources. The service was implemented in a pilot study with 29 patients in 4 iterative develop-test-learn cycles, with the engagement of developers, researchers, clinical teams, and patients. RESULTS: Patients reported outcomes daily for 30 days after surgery through Internet-of-Things (IoT) devices and a mobile app. The service's evaluation considered experience, feasibility, and effectiveness. It generated high satisfaction and high adherence among users, fewer readmissions, with an average of 7 ± 4.5 clinical actions per patient, primarily due to abnormal systolic blood pressure or wound-related issues. CONCLUSIONS: We propose a 6-step methodology to design and validate a high-value digital health care service based on collaborative learning, real-time development, iterative testing, and value assessment.

Impact of an Antimicrobial Stewardship Program in the First Year of Pandemic 2020 in a Large,Academic, Public Network Hospitals in Bogotá,Colombia

Background. Antimicrobial resistance is a major public health threat internationally but, particularly in Colombia. High and increasing rates of carbapenemases are challenging. Implementing antimicrobial stewardship programs (AMSs) in a large, academic, public network hospitals in Bogotá, Colombia.will help curb inappropriate antibiotic use. Methods. AMS was established in April 2020 consisting of an administrative champion, Infectious Diseases staff, nurse, General Physician, microbiologist, and pharmacists. Antimicrobial stewardship program interventions included postprescriptive audit and establishment of institutional guidelines. The AMS tracked appropriate drug selection including loading dose, maintenance dose, frequency, route, duration of therapy, de-escalation, and compliance with AMS recommendations. Defined daily dose (DDD) of drugs and health economics evaluations of antimicrobials (April-December 2020). Recommendations are placed in the electronic medical record as a progress note. Results. From April to December 2020, 1013 patients were evaluated by means of a prospective methodology. Unnecessary 689 days of hospitalization and 4420 days of antibiotic therapy were avoided. Among the top antibiotics discontinued were piperacillin tazobactam for the months of July, August, November and December, while for September and October was meropenem. The intensive care unit was the most frequently intervened service (52%), followed by hospitalization (43%) and the emergency department (5%).Over the course of the year, there was significant adherence to the program, with 100% in July, followed by 93.3% in April, 87% in December, 86.6% in May and June, 83% in November, 80% in September, 73.3% in August and 57% in October. The AMS program was able to save $47.409US in antibiotics and $55.529US in hospitalization, and 11% decrease in nephrotoxicity events (14 renal failures were avoided), which also saved additionally $ 23.503 US for a total of an estimated cost saving for the network public hospitals of $ 126.441 US by 2020. Conclusion. Implementation of a multidisciplinary antibiotic stewardship program in this academic, large, academic, public network hospitals in Bogotá, Colombia demonstrated feasibility and economic benefits even in a Covid19 pandemic situation.