Descrição e avaliação de indicadores de monitoramento do impacto econômico das pneumonias associadas à ventilação mecânica (PAVM)

Abstract

Healthcare-Associated Infections (HAIs) can be classified as infections that arise from care provided in a hospital or other healthcare facility and that were not present at the time of the patient's admission. Ventilator-associated pneumonia (VAP) is one of the most common infections that, in addition to increasing mortality, can lead to longer intensive care unit stays, potentially making hospitalizations more expensive. Therefore, the costs attributed to HAIs have become increasingly prominent, and current research on this subject demonstrates that there is a global economic impact, thus generating the need for studies focused on this topic in order to perform an economic assessment. In addition, the high consumption of medications, especially antimicrobials for treating these infections, can further promote the emergence of multidrug-resistant strains of microorganisms. In this sense, there is a need to invest in prevention, through the implementation of care packages in order to avoid these infections. Thus, this study aimed to describe and evaluate the indicators used to monitor the economic impact of ventilator-associated pneumonia (VAP). This is a descriptive study with a quantitative approach and an economic evaluation, exploratory and retrospective of the monitoring indicators for ventilator-associated pneumonia (VAP). The study took place at the Hospital Regional Norte, with the period studied between January 2021 and August 2022. During the period, 296 cases of HAI were observed in the institution, of which 176 notifications were from ventilator-associated pneumonia (VAP), users aged 58 years were the most prevalent. Of the 176 cases, 70 had ICD B34.2 - Coronavirus infection of unspecified location, bringing COVID-19 as the underlying disease, which led to hospitalization. Of the patients who had comorbidities, hypertension and DM were the most frequent. Regarding the microbiological profile, 40.34% of the cultures performed were positive for Acinetobacter baumannii, 23.30% for Pseudomonas aeruginosa and 16.48% for Klebsiella pneumoniae. The total costs of antimicrobials in the (ICU) reached a total of R$773,470.66 or $141,921.22 for 2021 and for 2022 R$417,223.65 or $76,554.80, drawing attention to the high consumption of meropenem and piperacillin with tazobactam. The average length of stay in the ICU was 30 days. For the cost parameter with pharmacological treatments including all pharmacotherapy used, it reached a total of R$1,661,817.17 or $304,920.50, which brought the value data for the treatment of VAP. The average value of the daily ICU stay was R$2,023.22 or $371.23. It was identified that it took on average 15.74 days after the patient's admission until the development of HAI, 22.31 days until the date of final diagnosis and 17.66 days until the date of clinical outcome. Of the clinical outcome, 69.31% evolved to death. A tool was applied to assess the economic impact related to VAP, called the PHARMACOTHERAPY COST RATE IN VAP Indicator, which concluded that 53.87% of the costs with pharmacological treatments in the ICU are due to VAP. The findings of this study reveal a high burden of Ventilator-Associated Pneumonia, which considerably increases the financial costs of health institutions. However, based on indicators and knowledge of the parameters, strategies can be drawn up to reduce them and better allocate the remaining resources.