Health> Vol.6 No.2, January 2014

Evaluation of rational use of antimicrobial agents in a Brazilian intensive care unit

ABSTRACT

The present study sought to assess the rational use of antimicrobial agents in a Brazilian intensive care unit (ICU) and its association with antimicrobial resistance in elderly patients admitted to the unit. Results: Choice of empiric and sensitivity-guided therapy was inadequate in > 80% and 59% of cases respectively. Inadequate antimicrobial therapy, whether empiric or sensitivity-guided, was positively correlated with bacterial resistance (r = 0.316; p = 0.001). Sensitivity testing revealed a 46.5% resistance rate to eight out of the ten most commonly used antibiotics. Multiple drug-resistant organisms were found in 40.8% of patients. A significant increase was observed in the number of multidrug-resistant samples between 2006/2007 and 2008 (r = 0.41, p = 0.006), (r = 0.598, p = 0.001), (r = 0.688, p = 0.00). Conclusion: We found a high rate of antibiotic misuse in the study sample. Inadequate therapy was correlated with resistance to antimicrobial agents.

KEYWORDS


Cite this paper

Cartaxo Salgado, F. , Gavilanes Sanchez, T. , da Silva, N. , Oliveira, H. , Karnikowski, M. and de Oliveira Karnikowski, M. (2014) Evaluation of rational use of antimicrobial agents in a Brazilian intensive care unit. Health, 6, 188-194. doi: 10.4236/health.2014.62028.

References

[1] De Carvalho, J.A. and Garcia, R.A. (2003) The aging process in the Brazilian population: A demographic approach. Cadernos de Saúde Pública, 19, 725-733.
http://dx.doi.org/10.1590/S0102-311X2003000300005
[2] Lima-Costa, M.F. and Veras, R. (2003) Aging and public health. Cadernos de Saúde Pública, 19, 700-701.
http://dx.doi.org/10.1590/S0102-311X2003000300001
[3] Penteado, P., Cunico, C., Oliveira, K. and Polichuk, M. (2002) The use of drugs by the elderly. Visão Acadêmica, 3, 35-42.
[4] Correa, L. (2007) Restrição ao uso de antimicrobianos no ambiente hospitalar. Einstein: Educação Continuada em Saúde, 5, 48-52.
[5] Eickhoff, T. (1992) Antibiotics and nosocomial infections. In: Bennet, J. and Brachman, P., Eds., Hospital Infections, 3rd Edition, Brown and Company, Boston, 245-264.
[6] Neu, H. (1993) Antimicrobial agents: Role in the prevention and control of nosocomial infections. In: Wenzel, R., Ed., Prevention and Control of Nosocomial Infections, 2nd Edition, Williams & Wilkins, Baltimore, 406-419.
[7] World Health Organization (2001) Global strategy for containment of antimicrobial resistance.
[8] Kollef, M.H. and Fraser, V.J. (2001) Antibiotic Resistance in the Intensive Care Unit. Annals of Internal Medicine, 134, 298-314.
http://dx.doi.org/10.7326/0003-4819-134-4-200102200-00014
[9] Brazil Ministry of Health (1998) Portaria GM no 3.916, 30 de outubro de 1998.
http://bvsms.saude.gov.br/bvs/saudelegis/gm/1998/prt3916_30_10_1998.html
[10] Brazil Ministry of Health (2004) Resolução No. 338, de 06 de maio de 2004.
http://bvsms.saude.gov.br/bvs/saudelegis../cns/2004/res0338_06_05_2004.html
[11] Struelens, M.J. (1998) The epidemiology of antimicrobial resistance in hospital acquired infections: Problems and possible solutions. The British Medical Journal, 317, 652-654. http://dx.doi.org/10.1136/bmj.317.7159.652
[12] Expert Commitee on National Drugs Policies (1995) Contribution to updating the WHO guidelines. WHO, Geneva.
[13] Unbound Medicine, Inc. (2009) The Jonh Hopkins ABX guide. http://www.hopkinsguides.com/hopkins/ub/index/Johns_Hopkins_ABX_Guide/Antibiotics
[14] Brazil, National Agency of Health Surveillance (2001) Consenso sobre o uso racional de antimicrobianos. Ministry of Health, National Agency of Health Surveillance, Brasilia.
[15] Dellinger, R.P., Levy, M.M., Carlet, J.M., et al. (2008) Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Critical Care Medicine, 36, 296-327.
http://dx.doi.org/10.1097/01.CCM.0000298158.12101.41
[16] National Committee for Clinical Laboratory Standards (NCCLS) (1997) Reference method for broth dilution antifungal susceptibility testing of yeasts. Approved standard M27-A. NCCLS, Wayne.
[17] Couto, R. (2003) Bactérias multirresistentes. In: Couto, R., Pedroza, T. and Nogueira, J., Eds., Infecção Hospitalar e Outras Complicações não Infecciosas da Doenç, 3rd Edition, Medsi, Rio de Janeiro, 557-588.
[18] Feijó, C.A., Bezerra, I.S., Peixoto Júnior, A.A. and Meneses, F.A. (2006) Morbidity and mortality of elderly patients admitted to an Intensive Care Unit of a University Hospital in Fortaleza. Revista Brasileira de Terapia Intensiva, 18, 263-267.
http://dx.doi.org/10.1590/S0103-507X2006000300008
[19] Koury, J.C., Lacerda, H.R. and Barros Neto, A.J. (2006) Characteristics of septic patients in an intensive care unit of a tertiary private hospital from Recife, northeast of Brazil. Revista Brasileira de Terapia Intensiva, 18, 52-58.
http://dx.doi.org/10.1590/S0103-507X2006000100010
[20] Machado, R.L., David, C.M., Luiz, R.R., et al. (2009) Related prognostic factors in elderly patients with severe sepsis and septic shock. Revista Brasileira de Terapia Intensiva, 21, 9-17.
http://dx.doi.org/10.1590/S0103-507X2009000100002
[21] Ibrahim, E.H., Sherman, G., Ward, S., Fraser, V.J. and Kollef, M.H. (2000) The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest, 118, 146-155.
http://dx.doi.org/10.1378/chest.118.1.156
[22] Luna, C.M., Vujacich, P., Niederman, M.S., et al. (1997) Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest, 111, 676-685.
http://dx.doi.org/10.1378/chest.111.3.676
[23] Rice, L.B. (2007) Emerging issues in the management of infections caused by multidrug-resistant gram-negative bacteria. Cleveland Clinic Journal of Medicine, 74, S12-S20. http://dx.doi.org/10.3949/ccjm.74.Suppl_4.S12
[24] Lima, A.P.., Gallani, N.R., Toledo, M.I. and Lopes, L.C. (2008) Use of Pharmacy Benefits Management (PBM) system to describe the profile of antibiotic prescription and purchase. Revista Brasileira de Ciências Farmacêuticas, 44, 215-223.
http://dx.doi.org/10.1590/S1516-93322008000200007
[25] Associação Paulista de Estudos e Controle de Infecçã Hospitalar (APECIH) (2007) Uso racional de anti-microbianos. In: Associação Paulista de Estudos e Controle de Infecção Hospitalar, Camara Brasileira do Livro, São Paulo.
[26] Fridkin, S., Lawton, R., Edwards, J.R., et al. (2002) Monitoring antimicrobial use and resistance: Comparison with a national benchmark on reducing vancomycin use and vancomycin-resistant enterococci. Emerging Infectious Diseases, 8, 702-707.
http://dx.doi.org/10.3201/eid0807.010465
[27] Patrick, D.M., Marra, F., Hutchinson, J., et al. (2004) Per capita antibiotic consumption: How does a North American jurisdiction compare with Europe? Clinical Infectious Diseases, 39, 11-17. http://dx.doi.org/10.1086/420825
[28] Rüttimann, S., Keck, B., Hartmeier, C., Maetzel, A. and Bucher, H.C. (2004) Long-term antibiotic cost savings from a comprehensive intervention program in a medical department of a university-affiliated teaching hospital. Clinical Infectious Diseases, 38, 348-356.
http://dx.doi.org/10.1086/380964
[29] White, R.L., Friedrich, L.V., Mihm, L.B. and Bosso, J.A. (2000) Assessment of the Relationship between antimicrobial usage and susceptibility: Differences between the hospital and specific patient-care areas. Clinical Infectious Diseases, 31, 16-23.
http://dx.doi.org/10.1086/313916
[30] Penteado Filho, S. (2004) Controle de antimicrobianos: Teorias, evidências e prática. Revista Prática Hospitalar, 6, 1-7.
[31] Rachid, M. and Schechteru, M. (2005) Manual de HIV-AIDS. 8th Edition, Revinter Ltda., S?o Paulo.
[32] Centers for Disease Control and Prevention (CDC) (2002) Campaign to prevent antimicrobial resistance in healthcare settings. 12 steps to prevent antimicrobial resistance among surgical patients.
http://www.kliinikum.ee/infektsioonikontrolliteenistus/doc/oppematerjalid/surgical.pdf
[33] Shlaes, D.M., Gerding, D.N., John Jr., J.F., et al. (1997) Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: Guidelines for the prevention of antimicrobial resistance in hospitals. Clinical Infectious Diseases, 25, 584-599.
http://dx.doi.org/10.1086/513766
[34] Weinstein, R.A. (2001) Controlling antimicrobial resistance in hospitals: Infection control and use of antibiotics. Emerging Infectious Diseases, 7, 188-192.
http://dx.doi.org/10.3201/eid0702.700188
[35] Cartaxo Salgado, F.X., Carneiro Goncalves, J., Monteiro De Souza, C., et al. (2011) Cost of antimicrobial treatment of patients infected with multidrug-resistant organisms in the Intensive Care Unit. Medicina (Buenos Aires), 71, 531-535.
[36] Centers for Disease Control and Prevention (1992) Public health focus: surveillance, prevention, and control of nosocomial infections. Morbidity and Mortaliy Weekly Report, 41, 783-787.
[37] Gaynes, R. (1997) The impact of antimicrobial use on the emergence of antimicrobial-resistant bacteria in hospitals. Infectious Disease Clinics of North America, 11, 757-765.
http://dx.doi.org/10.1016/S0891-5520(05)70388-3
[38] Jacoby, T. and Moreira, L. (2008) Associa??o entre consumo de antimicrobianos e multirresistência bacteriana em centro de terapia intensiva de hospital universitário brasileiro, 2004-2006. Master’s Thesis, Federal University of Rio Grande do Sul, Porto Alegre.
[39] Chow, J.W., Fine, M.J., Shlaes, D.M., et al. (1991) Enterobacter bacteremia: Clinical features and emergence of antibiotic resistance during therapy. Annuals of Internal Medicine, 115, 585-590.
http://dx.doi.org/10.7326/0003-4819-115-8-585
[40] Goldmann, D.A., Weinstein, R.A., Wenzel, R.P., et al. (1996) Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals. A challenge to hospital leadership. The Journal of the American Medical Association, 275, 234-240.
http://dx.doi.org/10.1001/jama.1996.03530270074035
[41] Johnson, M.P. and Ramphal, R. (1990) Betalactam-resistant Enterobacter bacteremia in febrile neutropenic patients receiving monotherapy. Jorunal of Infecious Diseases, 162, 981-983.
http://dx.doi.org/10.1093/infdis/162.4.981
[42] Worley, H. (2006) La resistencia a los antimicrobianos pone en riesgo el avance médico.
http://www.prb.org/SpanishContent/2006/LaResistenciaalosAntimicrobianosPoneenRiesgoelAvanceMedico.aspx
[43] Quadros, C. (2004) Estratégias para controle de resistência antimicrobiana em unidades de terapia intensiva. MBA Thesis, University City of S?o Paulo, S?o Paulo.
[44] Eickhoff, T. (1998) Antibiotics and nosocomial infections. In: Bennet, J. and Brachman, P., Eds. Hospital Infections, Lippincott-Raven, Philadelphia, 201-214.
[45] Dellit, T.H., Owens, R.C., McGowan, J.E., et al. (2007) Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for developing an institutional program to enhance antimicrobial stewardship. Clinical Infectious Diseases, 44, 159-177. http://dx.doi.org/10.1086/510393
[46] Centers for Disease Control and Prevention (CDC) (2001) A public health action plan to combat antimicrobial resistance. Part I. Domestic issues.
http://www.cdc.gov/drugresistance/actionplan/index.htm

comments powered by Disqus

Copyright © 2014 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.