Use of antimicrobials in a specialized cardiology hospital
DOI:
https://doi.org/10.21527/2176-7114.2024.48.14385Keywords:
Drug Utilization review, Antimicrobial Stewardship, Drug Resistance Multiple BacterialAbstract
The management of antimicrobial use has been recognized as a relevant action to mitigate irrational use and the increasing resistance to this class of drugs. Thus, the present study aimed to evaluate the use of antimicrobials by measuring consumption and assessing the appropriateness of treatment regarding indication, dose, and duration, from August to November 2019, in a cardiology specialized hospital. Empirically initiated treatments were also evaluated for their adequacy following culture results and antimicrobial sensitivity testing, with adjustments made as necessary. Additionally, the World Health Organization (WHO) classification was applied, categorizing antimicrobials into Access, Watch, and Reserve (AWaRe) groups based on the impact of their use on microbial resistance and the importance of their appropriate and restricted use. A total of 1558 prescriptions associated with 405 treatments were evaluated. The most commonly used therapeutic classes were combined penicillins, carbapenems, and third-generation cephalosporins. Adequacy in indication was observed in 84.2% of cases. Among these, 88.1% and 90.6% exhibited appropriate dose and treatment duration, respectively. Empirically initiated treatments were predominantly conducted (58.7%) with antimicrobials from the Watch group, followed by the Reserve group (23.5%) and Access group (17.8%). Therapy adjustment was performed in 59% of cases requiring it (57.9%). The results suggest that antimicrobial use should be optimized, aiming to minimize empirical use, favor the use of antimicrobials from the Access category, and promote the adequacy of empirical treatments following culture results.
References
Brasil. Diretriz Nacional para Elaboração de Programa de Gerenciamento do Uso de Antimicrobianos em Serviços de Saúde. Agência Nac Vigilância Sanitária [Internet]. 2017;90. Disponível em: https://www20.anvisa.gov.br/segurancadopaciente/index.php/publicacoes/item/diretriz-nacional-para-elaboracao-de-programa-de-gerenciamento-do-uso-de-antimicrobianos-em-servicos-de-saude
Mcewen S, Collignon PJ. Antimicrobial resistance: A One Health perspective. Trans R soc trop med hyg. 2017;111(6):255-260.
Mushtaq A, Awali RA, Chandramohan S, Krishna A, Biedron C, Jegede O, et al. Implementing an antibiotic stewardship program at a long-term acute care hospital in Detroit, Michigan. Am J infect control [Internet]. 2017;45(12):e157-160. DOI: https://doi.org/10.1016/j.ajic.2017.07.028
Verma M, Shafiq N, Tripathy JP, Nagaraja SB, Kathirvel S, Chouhan DK, et al. Antimicrobial stewardship programme in a trauma centre of a tertiary care hospital in North India: Effects and implementation challenges. J glob antimicrob resist [Internet]. 2019 jun. 1º [citado 2023 jan. 12];17:283-290. Disponível em: https://pubmed.ncbi.nlm.nih.gov/30836142/
Singh S, Menon VP, Mohamed ZU, Anil Kumar V, Nampoothiri V, Sudhir S, et al. Implementation and impact of an antimicrobial stewardship program at a tertiary care center in South India. Open forum infect dis. 2019;6(4):1-7.
Ruiz J, Salavert M, Ramírez P, Montero M, Castro I, González E, et al. Implantación de un programa de optimización y uso racional de antimicrobianos en un modelo de área clínica médica. Rev española quimioter. 2018;31(5):419-426.
Hayat K, Rosenthal M, Gillani AH, Chang J, Ji W, Yang C, et al. Perspective of key healthcare professionals on antimicrobial resistance and stewardship programs: A multicenter cross-sectional study from Pakistan. Front pharmacol. 2020 jan.;10:1-11.
Brasil AN de V em S. Resultados Parciais da autoavaliação dos programas de gerenciamento do uso de antimicrobianos [Internet]. 2019. [citado 2023 mar 1º]. Disponível em: https://app.powerbi.com/view?r=eyJrIjoiZGM5MTIzNzQtMjQ3Ni00NDcyLThkOGYtYWEzYzE5YzcyNWEzIiwidCI6ImI2N2FmMjNmLWMzZjMtNGQzNS04MGM3LWI3MDg1ZjVlZGQ4MSJ9
World Health Organization. 2021 AWaRe classification [Internet]. [citado 2023 mar. 3]. Disponível em: https://www.who.int/publications/i/item/2021-aware-classification
Porto APM, Goossens H, Versporten A, Costa SF. Global point prevalence survey of antimicrobial consumption in Brazilian hospitals. J hosp infect [Internet]. 2020 feb. 1º [citado 2023 mar. 7];104(2):165-171. Disponível em: http://www.journalofhospitalinfection.com/article/S0195670119304542/fulltext
Souza F, Baroni M, Roese F. Perfil de utilização de antimicrobianos na unidade de terapia intensiva de um hospital público. Rev bras farmácia hosp e serviços saúde. 2017;8(4):37-44.
Furlan PR, Melo N, Cruz C, Mariño PA, Menezes APS. Padrão de utilização de antibiótico em hospital no interior do Rio Grande do Sul. Antibiotic Use Pattern in Hospital in the Interior of Rio Grande do Sul. Brazilian J dev. 2020;6(9):66.387-66.397.
Robertson J, Iwamoto K, Hoxha I, Ghazaryan L, Abilova V, Cvijanovic A, et al. Antimicrobial Medicines Consumption in Eastern Europeand Central Asia – An Updated Cross-National Study and Assessment of QuantitativeMetrics for Policy Action. Front pharmacol. 2019 mar.;9:1-13.
Mas-Morey P, Ballesteros-Fernández A, Sanmartin-Mestre E, Valle M. Impact of clinical pharmacist intervention on antimicrobial use in a small 164-bed hospital. Eur J hosp pharm. 2018;25(e1):E46-51.
Balkhy HH, El-Saed A, El-Metwally A, Arabi YM, Aljohany SM, Al Zaibag M, et al. Antimicrobial consumption in five adult intensive care units: A 33-month surveillance study. Antimicrob resist infect control. 2018;7(1):1-9.
Chowdhury S, Sastry A, Sureshkumar S, Cherian A, Sistla S, Rajashekar D. The impact of antimicrobial stewardship programme on regulating the policy adherence and antimicrobial usage in selected intensive care units in a tertiary care center-A prospective interventional study. Indian J med microbiol [Internet]. 2020;38(3-4):362-370. DOI: https://doi.org/10.4103/ijmm.IJMM_20_326
Gutema G, Håkonsen H, Engidawork E, Toverud EL. Multiple challenges of antibiotic use in a large hospital in Ethiopia – A ward-specific study showing high rates of hospital-acquired infections and ineffective prophylaxis. BMC health serv res. 2018;18(1):1-7.
Al-Tawfiq JA, Al-Homoud AH. Pattern of systemic antibiotic use among hospitalized patients in a general hospital in Saudi Arabia. Travel med infect dis. 2020/out. 2019;36:428-431.
Cahill TJ, Harrison JL, Jewell P, Onakpoya I, Chambers JB, Dayer M, et al. Antibiotic prophylaxis for infective endocarditis: A systematic review and meta-Analysis. Heart. 2017;103(12):937-944.
Alves JCMM, Torres PHA. FACSETE Health Sciences Antibioticoterapia profilática em cirurgia oral e maxilofacial : uma revisão de literatura Prophylactic antibiotic therapy in oral and maxillofacial surgery : a literature review; 2022.
Hamilton WL, Pires SM, Lippett S, Gudka V, Cross ELA, Llewelyn MJ. The impact of diagnostic microbiology on de-escalation of antimicrobial therapy in hospitalised adults. BMC infect dis. 2020;20(1):1-7.
Tribble AC, Lee BR, Flett KB, Handy LK, Gerber JS, Hersh AL, et al. Appropriateness of Antibiotic Prescribing in United States Children’s Hospitals: A National Point Prevalence Survey. Clin infect dis. 2020;71(8):E226-34.
Nabor MIP, Buckley BS, Lapitan MCM. Compliance with international guidelines on antibiotic prophylaxis for elective surgeries at a tertiary-level hospital in the Philippines. Healthc Infect [Internet]. 2015;20(4):145-151. DOI: http://dx.doi.org/10.1071/HI15018
Cao H, Phe K, Laine GA, Russo HR, Putney KS, Tam VH. An institutional review of antimicrobial stewardship interventions. J glob antimicrob resist [Internet]. 2016;6:75-77. DOI: http://dx.doi.org/10.1016/j.jgar.2016.03.006
Pauwels I, Versporten A, Drapier N, Vlieghe E, Goossens H. Hospital antibiotic prescribing patterns in adult patients according to the WHO Access, Watch and Reserve classification (AWaRe): Results from a worldwide point prevalence survey in 69 countries. J antimicrob chemother. 2021;76(6):1.614-1.624.
Mugada V, Mahato V, Andhavaram D, Vajhala SM. Evaluation of prescribing patterns of antibiotics using selected indicators for antimicrobial use in hospitals and the access, watch, reserve (Aware) classification by the world health organization. Turkish J pharm sci. 2021;18(3):282-288.
Zhussupova G, Utepova D, Orazova G, Zhaldybayeva S, Skvirskaya G, Tossekbayev K. Evaluation of antibiotic use in Kazakhstan for the period 2017-2019 based on who access, watch and reserve classification (Aware 2019). Antibiotics. 2021;10(1):1-13.
Rashid MM, Akhtar Z, Chowdhury S, Islam MA, Parveen S, Ghosh PK, et al. Pattern of Antibiotic Use among Hospitalized Patients according to WHO Access, Watch, Reserve (AWaRe) Classification: Findings from a Point Prevalence Survey in Bangladesh. Antibiotics. 2022;11(6):1-14.
Moreira Santos J, Pedro Araújo Rocha J DE, Rodrigues Batista Oliveira L DE, Moreira Cunha L, Henrique Nacife Gomes L, Laguardia Valente Rocha L. Desafios da endocardite infecciosa: uma revisão integrativa. Challenges of Infectious Endocarditis: an Integrative Review. Brazilian J surg clin res BJSCR [Internet]. 2020;32(3):2.317-4.404. Disponível em: http://www.mastereditora.com.br/bjscr
Rocha E, Figueiredo CF, Leite DS, Kalume LB da C, Castanheira M de C, De Assis SKJS, et al. As evidências no tratamento farmacológico da endocardite infecciosa: uma revisão de literatura. Rev eletrônica acervo saúde. 2020;12(11):e4464.
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