Gerenciamento de antimicrobianos: análise das estratégias, terapia sequencial oral, ajuste de dose e otimização da dose em um hospital terciário público de ensino em Fortaleza-CE

Abstract

The management of antimicrobial use has become a global concern due to the high financial and health costs. In this sense, the Centers for Disease Control and Prevention implemented, in 2014, a policy for hospitals to mitigate this scenario. In Brazil, the program was implemented in 2017, through a National Guideline, which has strategies to optimize antimicrobial therapy that help in the clinical, microbiological, and economic outcome of the hospital. This aims to expose information that characterizes the patient who makes use of these strategies, to assist in the decision making of pharmacological therapy and to promote clinical pharmacy. The aim is to characterize the clinical-epidemiological, microbiological, and technical-operational profile in patients who used the therapy optimization strategies in a public tertiary teaching hospital, through a cross-sectional and retrospective study from the survey of information provided by the follow-up form of patients followed by the Antimicrobial Therapy Management Program (AMMP) team during the period from January 2020 to December 2021. A total of 453 patients were followed up, where the average length of stay is 39.80 days and the average age found was 55.19 years. There were 270 (59.60%) discharges and 179 (39.51%) deaths. There were 31 Oral Sequence Therapy (ORT), of which 2 were performed by the clinical pharmacist with 100% acceptance; 280 dose optimization, of which 31 were performed by the clinical pharmacist and 93.54% accepted; and 646 dose adjustment, of which 114 were performed by the clinical pharmacist with 100% acceptance. Of all the therapy optimization strategies, those conducted by the clinical pharmacist accounted for 144, corresponding to 15.04%. 5127 cultures were performed in the years 2020 and 2021, being the most requested blood cultures, with 2318 (45.21%). The classes of antimicrobials most present in the strategies were glycopeptides and carbapenems. Most infections were of blood focus, with a predominance of Klebsiella pneumoniae isolation in the biological samples. Thus, it is concluded that dose optimization therapies are valuable in the care setting, but that they need more space for the clinical pharmacist and more studies to support therapeutic conducts, following established protocols and criteria, in order to expand their use and bring better clinical, microbiological and economic outcomes.