Gestão clínica de antimicrobianos para o tratamento de pneumonia em um hospital privado de Fortaleza: características e impacto econômico

Abstract

The increased costs for health services due to factors such as increased length of stay and the need for more potent antimicrobials. Pneumonia is the third most common cause of death worldwide and is defined as acute pulmonary parenchyma infection. It can be caused by a variety of microorganisms and can be classified as community-acquired pneumonia (CAP), hospital-acquired pneumonia (PAH) and mechanical ventilationassociated pneumonia (VAP). This study aims to present the profile of antimicrobial use in a private hospital in Fortaleza, Ceará and the results of cost minimization and economic impact that the adoption of the strategies of the implanted antimicrobial management program brought to the health care provicter. This is a retrospective and descriptive study, consisting of a population of patients registered in the hearth care provicter systen, who were hospitalized in the study hospital and used antimicrobials for the treatment of pneumonia, from January 2010 to December 2018. Included in the study 3912 patients, of these there was a higher frequency of hospitalization of patients with age range 79 to 88 years and who were discharged as the main outcome. Regarding comorbidities, a high prevalence of hypertension and diabetes mellitus was also observed. And according to antimicrobial therapy, a higher frequency of broad spectrum antimicrobial use was observed, especially the beta lactam class with beta lactamase inhibitors, but a lower frequency of use of therapeutic reserve antimicrobials was observed. It was also observed a high frequency micro-organism culture, with the predominant isolation of gram negative, with ESBL resistance pattern. Regarding the economic aspects, it was possible to observe a significant reduction of costs related to antimicrobials, with the adoption of antimicrobial management strategies, which highlights one of the advantages of incorporating program strategies into the activities and flows of a hospital, highlighting time management strategies, oral sequential therapy and discontinuation of antimicrobial de-escalation of drug resistance.