Gestão de antimicrobianos pelo programa Stewardship em um hospital publico de ensino: análise da implantação

Abstract

One of the main global concerns regarding the rational use of medicines is related to the use of antimicrobials, which have had an irrational consumption pattern over the years, promoting the selection of multi-resistant microorganisms and the emergence of adverse events to medicines. In the hospital environment, infections associated with healthcare have been considered one of the most important public health problems and one of the most frequent adverse events. Although there are policies to control hospital infections in Brazil, they are still poorly articulated and are not based on an interdisciplinary model of clinical management. Therefore, the objective of this work was to evaluate the impact of the implementation of the Stewardship Program in a teaching hospital in Northeastern Brazil. The study was descriptive, retrospective and based on documents with data from February 2017 to January 2018. The results show 447 patients using reserve antimicrobials (need to fill out the application form) or strategic (subject to optimization such as therapy sequential oral) with 239 (53.47%) male with a mean age of 55.78 years (SD ± 16.20) and with a mean hospital stay of 27 days. Most patients were in intensive care. 1165 antimicrobials were monitored, of which 965 (82.83%) were of therapeutic reserve and 200 (17.17%) were strategic. The Kaplan-Meier method was used to estimate the survival curve and to verify if there was a statistical difference, the Mantel-Cox and Breslow tests were performed, which showed a statistical difference in the patients' survival at the end of the program implementation (p = 0.004 and 0.021, respectively). The most recommended program strategy was dose optimization, followed by the completion of treatment strategy with acceptance rates of 95% and 98%, respectively. Saving the sum of avoided costs with the strategies for reducing treatment time and sequential oral therapy, savings of R $ 68,589.13 were obtained in one year of implementation of the Stewardship program. Of the cases in which the culture test was requested, in 73.72% there was no growth of microorganisms (negative cultures). It was observed that out of a total of 425 isolates in the culture tests of microorganisms, 87 (20.47%) presented KPC microbiological profile. The microorganism with the most common KPC profile was Klebsiella pneumoniae, representing 41.37% of the isolates. The percentage of deaths was higher in patients with positive blood culture, with 42.9%, when compared to those who had negative blood culture, with 24.8%.