Análise da implementação do programa de gerenciamento de antimicrobianos na emergência de um hospital do Ceará

Abstract

Antimicrobial resistance is a major global public health challenge, requiring effective strategies to promote the rational use of antimicrobials and reduce bacterial resistance. The Antimicrobial Stewardship Program (ASP) is essential in hospitals, especially in ICUs, but it is also crucial in the emergency department due to the need for rapid interventions in infection control. The study aimed to analyze the implementation of the ASP in the emergency department of a hospital specialized in cardiology and pulmonology in Ceará. This is a prospective, descriptive and quantitative study, which used as the main data source the ASP pharmacotherapeutic monitoring form in the emergency department. Prospective audits with feedback were carried out where the recommendations were discussed and recorded. The sample consisted of 385 patients, with a mean age of 68.52 years, of which 54.03% were male. The mean hospital stay was 18.87 days, while in the emergency department it was 5.27 days. The most common admission diagnoses were decompensated heart failure (111 cases, 28.83%) and acute myocardial infarction (71 cases, 18.45%). The most prevalent infection was community-acquired pneumonia (147 cases, 38.18%), followed by nosocomial pneumonia (76 cases, 19.74%). Ceftriaxone was the most prescribed antimicrobial (190 prescriptions, 21.70%), followed by piperacillin + tazobactam (189, 21.70%). The main strategies adopted were dose adjustment (185 cases, 30.53%), reduction of treatment time (125 cases, 20.63%), and escalation (115 cases, 18.98%). Of the total, 310 prescriptions (80.52%) followed institutional protocols, while 75 (19.48%) were not in accordance. Cultures were requested before starting antimicrobials in 194 cases (50.39%), not requested in 30 (7.80%), and not applicable in 161 cases (41.81%). Discharge was associated with male patients, early old age, longer hospital stay, and early antibiotic discontinuation. Death was associated with advanced age, previous hospitalization, and a greater number of pharmaceutical interventions. The results are expected to encourage new long-term studies to improve clinical strategies for antimicrobial management in emergency services.