Análise da resistência bacteriana em unidades de terapia intensiva por meio de um programa de gerenciamento de antimicrobianos de um hospital privado de Fortaleza-Ceará durante a pandemia da COVID-19

Abstract

The COVID-19 pandemic in Brazil, in the years 2020 and 2021, was marked by two waves with a large number of infections and deaths. During this period, there was a significant increase in the consumption of antimicrobials, which intensifies concerns about bacterial resistance, especially in intensive care. The Antimicrobial Stewardship is a fundamental instrument in preventing the spread of resistant microorganisms. Thus, this study aims to analyze bacterial resistance to antimicrobials in ICU patients in a private hospital in Fortaleza, Ceará, during the period of the first and second waves of COVID-19. This is a comparative, descriptive, retrospective and quantitative study, with an analysis period from March 2020 to July 2021. The first wave was defined from March to September 2020, while the second was established from October 2020 to July 2021. Patients admitted to the ICU who received antimicrobial treatment in their clinical condition in the aforementioned period were included. Data were obtained from 1782 hospitalizations, subdivided into 554 in the first wave and 1228 in the second. Patients in the first wave were, on average, older than those in the second. There were percentage increases in the number of discharges and deaths, as well as in length of stay. Regarding the microorganisms found, the increase of Acinetobacter baumannii and Stenotrophomonas maltophilia, as well as of Coagulase Negative Staphylococcus, stands out. In addition, there was an increase in KPC bacteria. Regarding antimicrobials, it was noted, between the waves, an increase in the time of use and a greater use of those of broad spectrum. The main pharmaceutical interventions performed were dose and time adjustment, which showed a considerable increase in requests in the second wave. Finally, there was also a decrease in the acceptability of these interventions between the periods. Therefore, there was a considerable increase in bacterial resistance between the waves of COVID-19, related to the intensive use of antimicrobials, especially of broad spectrum. Further studies are encouraged, which may establish greater relationships between the increase in bacterial resistance in the waves of COVID-19 infections and the indiscriminate use of antimicrobials.