Avaliação da intervenção de descalonamento como uma estratégia de otimização terapêutica em um programa de gerenciamento do uso de antimicrobianos em um hospital de ensino

Abstract

Antimicrobial Stewardship Program is a measure that aims to ensure the rational use of antimicrobials, using therapeutic optimization strategies to ensure more effective therapy, in addition to combating microbial resistance. De-escalation appears as one of these interventions and can be defined as decrease the antimicrobial spectrum taking into account the susceptibility of the pathogen and ensuring the reduction of selective pressure caused by these drugs thus combating microbial resistance. Therefore, the present study aims to evaluate the de-escalation strategy during the years 2018 to 2020. For this, the patients were followed up through the monitoring form of the use of antimicrobials, after the clinical outcome the data were audited and imported into a database for further analysis. Patients with the accepted de-escalation strategy were evaluated in order to analyze the demographic, pharmacotherapeutic and microbiological profile, in addition to cost analysis, AntimicrobialFree Days and other outcomes. A total of 363 patients were evaluated with a total of 799 suggested and accepted interventions. The acceptance rate of the strategy was 99.75% (799/801). De-escalation with antimicrobial removed corresponded to 90.11% (n=720). The most used antimicrobials were therapeutic reserve with 89.48% (n=715). Regarding the frequency of de-escalations, broad-spectrum antimicrobials were the most prevalent deescalation, with meropenem being the main representative with 20.53% (n=164). The microbiological profile showed the prevalence of the presence of Klebsiella pneumoniae with 20.11% (n=35). The de-escalation strategy had a significant result in the reduction of treatment time between the days foreseen and performed of the initial therapy, statistical relevance (p<0.0001) was observed for the three years analyzed. The Antimicrobials freedays corresponded to 29.20% (3210/10993) and the avoided cost rate was 21.81% with a financial balance of R$ 378,887.01 between 2018 and 2020. Regarding the clinical outcome, it was seen that hospital discharge was higher than death corresponding to 65.56% (n=238). Thus, the de-escalation strategy is important with regard to the reduction of exposure to the use of antimicrobials, through the reduction of treatment days reducing selective pressure by unnecessary exposure and through cost reduction, enabling a positive financial balance.