Reduction of antimicrobial treatment time in intensive care units in Fortaleza, Brazil

Authors

  • Angelina Almeida Bastos Federal University of Ceará, Walter Cantídio University Hospital, Multiprofessional Integrated Residency Program in Hospital Health Care, Fortaleza, Brazil. https://orcid.org/0000-0002-8908-7186
  • Elana Figueiredo Chaves Federal University of Ceará, Walter Cantídio University Hospital, Multiprofessional Integrated Residency Program in Hospital Health Care, Fortaleza, Brazil. https://orcid.org/0000-0002-5817-0999
  • Maria Luiza Almeida Bastos Federal University of Ceará, Faculty of Medicine, Community Health Department, Fortaleza, Brazil. https://orcid.org/0000-0003-2427-5896
  • Bruna Suellen Pereira Federal University of Ceará, Walter Cantídio University Hospital, Multiprofessional Integrated Residency Program in Hospital Health Care, Fortaleza, Brazil.
  • Márcio de Souza Cavalcante Federal University of Ceará, Walter Cantídio University Hospital, hospital pharmacy service, Fortaleza, Brazil. https://orcid.org/0000-0003-1045-7912
  • Henry Pablo Lopes Campos e Reis Federal University of Ceará, Walter Cantídio University Hospital, hospital pharmacy service, Fortaleza, Brazil.
  • José Martins de Alcântara Neto Federal University of Ceará, Walter Cantídio University Hospital, hospital pharmacy service, Fortaleza, Brazil.
  • Cinthya Cavalcante de Andrade Federal University of Ceará, Walter Cantídio University Hospital, hospital pharmacy service, Fortaleza, Brazil.

DOI:

https://doi.org/10.30827/ars.v64i3.27830

Keywords:

Anti-Inflammatory Agents, Antimicrobial Stewardship, Critical Care, Drug Utilization

Abstract

Objective: To evaluate the application of the Antimicrobial (ATM) treatment time reduction strategy in Intensive Care Units (ICU) in an Antimicrobial Stewardship Program (ASP).

Method: This is a descriptive and cross-sectional study, carried out in two ICU of a university hospital in Fortaleza, Brazil, from January/2017 to January/2019. Adult patients were included, accompanied by a pharmacist, and using ATM, in which the treatment time reduction strategy was applied. The evaluation of the strategy was made through the difference between the predicted time established at the beginning of the treatment and the effective days of use of each ATM.

Results: Of the 100 patients included, 51.0 % were male and 64.0 % were elderly. The respiratory system was the most frequently affected by the infections (37.4 %) and the most prevalent classes of ATM were carbapenems (23.0 %) and glycopeptides (20.1 %). There was a decrease from 831 unnecessary days of antimicrobial therapy and from an average of 13.7 to 8.9 days of treatment. The greatest reductions in days were observed for meropenem, with 202 days reduced. The study also allowed the identification of associations between the reduction > 8 days of treatment and the variables length of stay > 22 days and patients in exclusive palliative care, and associations between hospital discharge and reductions of up to 7 days of therapy.

Conclusions: The data obtained suggest that the presence of an ASP influences the practices of ATM use and its treatment time and emphasize the role of pharmaceutical professionals in these programs.

Downloads

Download data is not yet available.

References

Browne AJ, Chipeta MG, Haines-Woodhouse G, Kumaran EPA, Hamadani BHK, Zaraa S, et al. Global antibiotic consumption and usage in humans, 2000–18: a spatial modelling study. Lancet Planet Health 202;5:e893–904. doi: 10.1016/ S2542-5196(21)00280-1.

Spellberg B, Gilbert DN. The future of antibiotics and resistance: a tribute to a career of leadership by John Bartlett. Clin Infect Dis. 2014;59 Suppl 2(Suppl 2):S71-5. doi: 10.1093/cid/ciu392.

Michael CA, Dominey-Howes D, Labbate M. The antibiotic resistance crisis: causes, consequences, and management. Front Public Health 2014;2:145. doi: 10.3389/fpubh.2014.00145.

Milani RV, Wilt JK, Entwisle J, Hand J, Cazabon P, Bohan JG. Reducing inappropriate outpatient antibiotic prescribing: normative comparison using unblinded provider reportsBMJ Open Quality 2019;8:e000351. doi: 10.1136/bmjoq-2018-000351.

Milani RV, Wilt JK, Entwisle J, Hand J, Cazabon P, Bohan JG. Antimicrobial resistance: one world, one fight! Antimicrob Resist Infect Control. 2015;4(1):1–15. doi: 10.1186/s13756-015-0091-2.

Versporten A, Zarb P, Caniaux I, Gros MF, Drapier N, Miller M, et al. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey. Lancet Glob Health. 2018;6(6):e619–e629. doi: 10.1016/S2214-109X(18)30186-4.

Timsit JF, Bassetti M, Cremer O, Daikos G, de Waele J, Kallil A, et al. Rationalizing antimicrobial therapy in the ICU: a narrative review. Intensive Care Med. 2019;45(2):172-89. doi: 10.1007/s00134-019-05520-5.

Lanckohr C, Bracht H. Antimicrobial stewardship. Curr Opin Crit Care. 2022 Oct 1;28(5):551-6. doi: 10.1097/MCC.0000000000000967.

Garau J, Bassetti M. Role of pharmacists in antimicrobial stewardship programmes. Int J Clin Pharm. 2018t;40(5):948-52. doi: 10.1007/s11096-018-0675-z.

Hayashi Y, Paterson DL. Strategies for reduction in duration of antibiotic use in hospitalized patients. Clin Infect Dis. 2011;52(10):1232-40. doi: 10.1093/cid/cir063.

Pasquau J, Matesanz M. La duración del tratamiento antibiótico. Rev Esp Quimioter 2015; 28 (Suppl. 1): 30-33.

Mendelson M, Morris AM, Thursky K, Pulcini C. How to start an antimicrobial stewardship programme in a hospital. Clin Microbiol Infect. 2020;26(4):447-53. doi: 10.1016/j.cmi.2019.08.007.

Monteiro KC. Gestão de antimicrobianos pelo programa stewardship em um hospital público de ensino: análise da implantação. Fortaleza. Dissertação [Programa de Pós-Graduação em Ciências Farmacêuticas]. Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem; 2019.

Brasil; Ministério da Saúde. Estatuto do Idoso 3a edição 2a reimpressão [Internet]. Brasília: Ministério da Saúde; 2013. 72 p. Available from:.

World Health Organization. The anatomical therapeutic chemical classification system with defined daily doses (ATC/DDD). Norway: WHO. 2006. https ://www.whocc .no/atc_ddd_index/. Accessed 01 Jan 2022.

Pickens CI, Wunderink RG. Principles and Practice of Antibiotic Stewardship in the ICU. Chest. 2019;156(1):163-71. doi: 10.1016/j.chest.2019.01.013.

Hashimoto M, Asai S, Umezawa K, Kohara K, Miyazawa M, Suzuki Y, et al. Impact of ward pharmacist-led antimicrobial stewardship in intensive care units. J Chemother. 2022:1-10. doi: 10.1080/1120009X.2022.2087652.

Wunderink RG, Srinivasan A, Barie PS, Chastre J, Dela Cruz CS, Douglas IS, et al. Antibiotic Stewardship in the Intensive Care Unit. An Official American Thoracic Society Workshop Report in Collaboration with the AACN, CHEST, CDC, and SCCM. Ann Am Thorac Soc. 2020;17(5):531-40. doi: 10.1513/AnnalsATS.202003-188ST.

Favarin SS, Camponogara S. Perfil dos pacientes internados na unidade de terapia intensiva adulto de um hospital universitário. Rev Enferm da UFSM. 2012;2(2):320–9.

Melo ACL, Menegueti MG, Laus AM. Profile of patientes in Intensive Care: Considerations for teh nursing team. J Nurs UFPE. 2014;8(7):3142–8.

Associação Brasileira de Medicina Intensiva. Projeto UTIs brasileiras: características demográficas dos pacientes de UTIs adulto dos hospitais participantes [Internet]. 2019 [cited 2019 Nov 21]. Available from: http://www.utisbrasileiras.com.br/uti-adulto/caracteristicas-demograficas/.

Silva E, Dalfior Junior L, Fernandes HS, Moreno R, Vincent JL. Prevalência e desfechos clínicos de infecções em UTIs brasileiras: subanálise do estudo EPIC II. Rev Bras Ter Intensiva. 2012;24(2):143–50.

Loss SH, Nunes DSL, Franzosi OS, Salazar GS, Teixeira C, Vieira SRR. Doença crítica crônica: estamos salvando ou criando vítimas? Rev Bras Ter Intensiva. 2017;29(1):87–95. doi: 10.5935/0103-507X.20170013.

Montrucchio G, Sales G, Corcione S, Derosa FG, Brazzi L. Choosing wisely: what is the actual role of antimicrobial stewardship in intensive care units? Minerva Anestesiol. 2019;85(1):71–82. doi: 10.23736/S0375-9393.18.12662-9.

Oshima T, Kodama Y, Takahashi W, Hayashi Y, Iwase S, Kurita T, et al. Empiric antibiotic therapy for severe sepsis and septic shock. Surg Infect (Larchmt). 2016;17(2):210–6. doi: 10.1089/sur.2014.096.

Morello LG, Dalla-costa LM, Fontana RM, Netto ACSO, Petterle RR, Conte D, et al. Avaliação das características clínicas e epidemiológicas de pacientes com e sem sepse nas unidades de terapia intensiva de um hospital terciário. Einstein. 2019;17(2):1–8. doi: 10.31744/einstein_journal/2019AO4476.

Niederman MS, Baron RM, Bouadma L, Calandra T, Daneman N, DeWaele J, et al. Initial antimicrobial management of sepsis. Crit Care. 2021;25(1):307. doi: 10.1186/s13054-021-03736-w.

Brahmi N, Blel Y, Kouraichi N, Ben Hamouda R, Thabet H, Amamou M. Impact d’une politique de prescription d’antibiotiques dans un service de réanimation Tunisien [Impact of antibiotic use and prescribing policy in a Tunisian intensive care unit]. Med Mal Infect. 2006 Sep;36(9):460-5. French. doi: 10.1016/j.medmal.2006.07.012.

Ntagiopoulos PG, Paramythiotou E, Antoniadou A, Giamarellou H, Karabinis A. Impact of an antibiotic restriction policy on the antibiotic resistance patterns of Gram-negative microorganisms in an Intensive Care Unit in Greece. Int J Antimicrob Agents. 2007;30(4):360-5. doi: 10.1016/j.ijantimicag.2007.05.012.

Okumura LM, Silva MM, Veroneze I. Effects of a bundled Antimicrobial Stewardship Program on mortality: a cohort study. Braz J Infect Dis. 2015;19(3):246-52. doi: 10.1016/j.bjid.2015.02.005.

Taggart LR, Leung E, Muller MP, Matukas LM, Daneman N. Differential outcome of an antimicrobial stewardship audit and feedback program in two intensive care units: a controlled interrupted time series study. BMC Infect Dis. 2015;15:480. doi: 10.1186/s12879-015-1223-2.

Kaki R, Elligsen M, Walker S, Simor A, Palmay L, Daneman N. Impact of antimicrobial stewardship in critical care: a systematic review. J Antimicrob Chemother. 2011;66(6):1223–30. doi: 10.1093/jac/dkr137.

Peto Z, Benko R, Matuz M, Csullog E, Molnar A, Hajdu E. Results of a local antibiotic management program on antibiotic use in a tertiary intensive care unit in Hungary. Infection. 2008;36(6):560-4. doi: 10.1007/s15010-008-7377-8.

Zilahi G, McMahon MA, Povoa P, Martin-Loeches I. Duration of antibiotic therapy in the intensive care unit. J Thorac Dis. 2016;8(12):3774–80. doi: 10.21037/jtd.2016.12.89.

Montrucchio G, Sales G, Corcione S, De Rosa FG, Brazzi L. Choosing wisely: what is the actual role of antimicrobial stewardship in Intensive Care Units? Minerva Anestesiol. 2019;85(1):71-82. doi: 10.23736/S0375-9393.18.12662-9.

Israelsen SB, Fally M, Tarp B, Kolte L, Ravn P, Benfield T. Short-course antibiotic therapy for hospitalized patients with early clinical response in community-acquired pneumonia: a multicentre cohort study. Clin Microbiol Infect. 2022:S1198-743X(22)00420-7. doi: 10.1016/j.cmi.2022.08.004.

Timsit JF, Bassetti M, Cremer O, Daikos G, de Waele J, Kallil A, et al. Rationalizing antimicrobial therapy in the ICU: a narrative review. Intensive Care Med. 2019;45(2):172-89. doi: 10.1007/s00134-019-05520-5.

Montravers P, Tubach F, Lescot T, Veber B, Esposito-Farèse M, Seguin P, et al. Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomised clinical trial. Intensive Care Med. 2018;44(3):300-310. doi: 10.1007/s00134-018-5088-x.

López-Viñau T, Peñalva G, García-Martínez L, Castón JJ, Muñoz-Rosa M, Cano Á, et al. Impact of an Antimicrobial Stewardship Program on the Incidence of Carbapenem Resistant Gram-Negative Bacilli: An Interrupted Time-Series Analysis. Antibiotics (Basel). 2021;10(5):586. doi: 10.3390/antibiotics10050586.

Wilson APR. Sparing carbapenem usage. J Antimicrob Chemother. 2017;72(9):2410–7. doi: 10.1093/jac/dkx181.

Gauzit R, Pean Y, Alfandari S, Bru JP, Bedos JP, Rabaud C, et al. Carbapenem use in French hospitals: A nationwide survey at the patient level. Int J Antimicrob Agents. 2015;46(6):707–12. doi: 10.1016/j.ijantimicag.2015.08.013.

Rossi F. The challenges of antimicrobial resistance in Brazil. Clin Infect Dis. 2011. 4;52(9):1138-43. doi: 10.1093/cid/cir120.

Helset E, Nordøy I, Sporsem H, Bakke VD, Bugge JF, et al. Factors increasing the risk of inappropriate vancomycin therapy in ICU patients: A prospective observational study. Acta Anaesthesiol Scand. 2020;64(9):1295-1304. doi: 10.1111/aas.13658.

Vazquez-Guillamet C, Kollef MH. Treatment of gram - positive infections in critically ill patients. BMC Infect Dis. 2014;14:92. doi: 10.1186/1471-2334-14-92.

Downloads

Published

2023-06-20

How to Cite

1.
Almeida Bastos A, Figueiredo Chaves E, Almeida Bastos ML, Suellen Pereira B, de Souza Cavalcante M, Lopes Campos e Reis HP, Martins de Alcântara Neto J, Cavalcante de Andrade C. Reduction of antimicrobial treatment time in intensive care units in Fortaleza, Brazil. Ars Pharm [Internet]. 2023 Jun. 20 [cited 2024 May 20];64(3):243-55. Available from: https://revistaseug.ugr.es/index.php/ars/article/view/27830

Issue

Section

Original Articles