Avaliação do programa de gerenciamento do uso de antimicrobianos no tratamento da osteomielite em um hospital privado de Fortaleza, Ceará

Abstract

The antimicrobial stewardship program results in strategies for the rational use of antimicrobials and is very important for long-term infections, such as osteomyelitis. Osteomyelitis is an infection caused in bone tissue that has prolonged treatment with antimicrobials, contributing to the increase of resistant bacteria. Thus, this study has a objective to evaluate the stewardship program that use of antimicrobials in the treatment of osteomyelitis in a private hospital in Fortaleza, Ceará. It is a retrospective, descriptive and quantitative study of patients over 18 years old, admitted in the year 2015 to 2019, diagnosed with osteomyelitis and followed by the antimicrobial use management program in a private hospital, which is accredited to a health insurance carrier. The study evaluated the profile of 182 hospitalizations, the majority of which were male, with a prevalence of the age group from 69 to 78 years old, with prevalence of discharge in outcome, having a average of 42 days of internment. Among the most prevalent comorbidities were diabetes mellitus and essential hypertension. Most of the cultures requested were blood cultures and tissue, bone and wound material. Almost half of cultures requested were positive. Gram negative bacteria had the highest prevalence and 70% of the bacteria isolated were Pseudomonas spp., Klebsiella spp., Candida non-albicans, Enterococcus spp., Escherichia spp., Acinetobacter spp. and Staphylococcus aureus. As for the resistance standard, there is a greater predominance of ESBL and KPC. The average duration of antimicrobial use was 17 days, with carbapenems, glycopeptides, beta lactams + beta lactamase inhibitors, lipopeptides, and quinolones being the most used classes of antimicrobials. The interventions that had the highest frequency of acceptation were escalation and de-escalation, with the time intervention being the highest in number of requests. The program saved R$ 12,615.97 and the documents reports showed that the treatment time, antimicrobial suspension and acording to the treatment were the most accepted points by the attending physicians. Thus, this study demonstrated that the antimicrobial stewardship program has contributed to the adequate treatment with the support of specialists and guided by cultures, besides cooperating to reduce bacterial resistance and treatment costs for patients with osteomyelitis