Análise de dados de um programa de gerenciamento de antimicrobianos no período anterior e durante a pandemia de COVID-19 em um hospital privado de Fortaleza- CE

Abstract

Introduction: Antimicrobial (ATM) Stewardship Program is a strategy to curb the increase in antimicrobial resistance (AMR) that has intensified with the COVID-19 pandemic. Objective: Evaluation of strategies for monitoring the Antimicrobial Stewardship Program (ASP) at a private hospital in Fortaleza, CE, from a period before (2018/19) and during the COVID-19 pandemic (2020/21). Methodology: A descriptive and analytical cross-sectional study was conducted using secondary data from the Antimicrobial Stewardship Program from the healthcare provider implemented at Unimed Hospital. The studied population consisted of patients following the criteria of: (i) older than age of 18 years old, (ii) had used ATM, (iii) had been admitted to wards and intensive care units (ICU), and (iv) had had a clinical outcome (death, discharge or transfer) during the study period. One patient with incomplete information was excluded. The data was collected from the healthcare provider’s online system, stored at MS Excel 2016 and analyzed with StataSE statistical program. Results: It was observed a change in the age group with higher frequency. Before the pandemic, the 60 to 80 age group had accounted for 37.15% of the patients, while during the pandemic (2021), it had moved to the 19 to 59 age group with 45.56% of the patients. The time of hospitalization was mostly up to 14 days and the most prevalent clinical outcome was hospital discharge, representing 77.32% and 72.17% before and during the pandemic respectively. The microbiological profile showed a reduction in the number of positive cultures, an increase in the number of isolated fungal and an increase in ERC-type microbial resistance during the pandemic. Before the pandemic, 50.88% (29;57) of the Acinetobacter baumannii culture was resistant to carbapenem, and, during the pandemic, the resistance increased to 79.83% (277; 347). Also, 29.09% (96; 330) of the Klebsiella pneumoniae culture was resistant to carbapenem, and, during the pandemic, the resistance increased to (300; 549). The main ATMs used on wards were: (i) Ceftriaxone sodium, which use increased over the four years; (ii) Piperacillin + tazobactam, and (iii) Meropenem. The main ATMs used in ICU were: (i) Meropenem; (ii) Piperacillin + tazobactam, and (iii) vancomycin hydrochloride. The use of Meropenem and Polymyxin B increased in 2021. As for pharmaceutical interventions, the time management strategy was less accepted during the pandemic, while other strategies were more accepted (e.g., de-escalation). Conclusion: It was possible to evaluate different parameters monitored by ASP. Furthermore, the results suggest the need of strengthening strategies for a better use of ATM, such that the AMR can be reduced