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Vigilância do consumo de antibacterianos em meio hospitalar
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Resumo(s)
Os antibacterianos são um dos fármacos mais prescritos nos hospitais, onde o risco de aparecimento e transmissão de microrganismos resistentes é superior. Estudos de vigilância de consumo permitem identificar utilizações inadequadas.
Objectivos: Avaliar o padrão de consumo de antibacterianos nos serviços de
internamento do Hospital da Luz e quantificar a utilização pelo cálculo das DDD/100 camas-dia.
Métodos: Estudo observacional retrospectivo. Analisaram-se as prescrições de antibacterianos para uso sistémico (grupo J01 da Anatomical Therapeutic Chemical - ATC), registadas nos processos de doentes maiores de 18 anos, admitidos entre 1 de Janeiro e 31 de Março de 2011.
Resultados: Analisaram-se 2971 prescrições. As classes terapêuticas mais prescritas foram as cefalosporinas de primeira geração (53,7%), seguidas das penicilinas (10,3%). Cerca de 90% dos antibacterianos foram utilizados na via de administração injectável. A indicação mais frequente foi a profilaxia cirúrgica (65,2%). A terapêutica dirigida verificou-se em 3,0% das prescrições. Identificaram-se prescrições com indicação não esclarecida (4,9%). Em 4,2% desconheceu-se o motivo de suspensão, em 2,8% realizou-se o switch i.v. para oral e a suspensão por isolamento microbiológico foi de 1,5%. As infecções respiratórias baixas (44,5%) foram o diagnóstico mais frequente. Os antibacterianos mais prescritos em terapêutica foram as combinações de penicilinas com inibidores das beta-lactamases (24,3%), as cefalosporinas de terceira geração (14,6%) e as quinolonas (14,0%). A administração da profilaxia foi exclusivamente intra-operatória em 54,5% dos casos e estendeu-se depois das 24 horas em 12,1%. O consumo total de antibacterianos foi de 55,01 DDD/100 camas-dia.
Conclusões: Identificaram-se objectivos para a melhoria da qualidade da prescrição de antibacterianos no Hospital da Luz: utilização excessiva da via de administração injectável; escassas prescrições dirigidas; motivos de suspensão desconhecidos; reduzidos motivos de suspensão por isolamento microbiológico e por switch i.v. para oral; prescrições com indicação não esclarecida; antibioterapia de largo espectro; duração de profilaxia superior a 24 horas.
Antibacterial agents are one of the most prescribed drugs in hospitals, where emergence risk and resistant microorganisms transmission is high. Consumption surveillance studies allow identifying inappropriate antibiotic use. Objectives: To assess the use pattern of antibacterial agents of inpatientat Hospital da Luz and to quantify antibacterial consumption expressed by DDD/100 bed-days. Methods: Retrospective observational study. Prescriptions of antibacterials for systemic use (Anatomical Therapeutic Chemical J01 group), recorded in medication records of patients over 18 years old, admitted from Jan 1st to March 31st 2011, were analysed. Results: A total of 2971 prescriptions were analysed. The most frequently prescribed therapeutic classes were 1st generation cephalosporins (53.7%), followed by penicillins (10.3%). Almost 90% of antibacterials were used by parenteral route. The most recurrent indication was surgical prophylaxis (65.2%). Culture-directed treatment appeared in 3.0%. Prescriptions with an unclear indication were identified (4.9%). Reason for withdrawing was unknowning 4.2% cases, in 2.8% an iv-to-oral switch occurred, and in 1.5% antibacterials were switched according to microbiological isolation. Lower respiratory tract infections were the most frequent diagnose (44.5%). The highest percentage of antibacterials prescribed for therapeutic purposes were combinations of penicillins with beta-lactam inhibitors (24.3%), 3rd generation cephalosporins (14.6%) and quinolones (14.0%). Prophylaxis was exclusively intraoperative in 54.5% cases, and was extended for more than 24 hours in 12.1%. Total antibacterial consumption was 55.01 DDD/100 bed-days. Conclusion: Targets for quality improvement of antibacterial use were identified in Hospital da Luz: abuse of parenteral route; reduced culture- irected treatments; unknown withdrawal reasons, reduced microbiological isolation and iv-to-oral switch; unclear indication; excess of broad-spectrum antibacterials; prophylaxis duration over 24 hours.
Antibacterial agents are one of the most prescribed drugs in hospitals, where emergence risk and resistant microorganisms transmission is high. Consumption surveillance studies allow identifying inappropriate antibiotic use. Objectives: To assess the use pattern of antibacterial agents of inpatientat Hospital da Luz and to quantify antibacterial consumption expressed by DDD/100 bed-days. Methods: Retrospective observational study. Prescriptions of antibacterials for systemic use (Anatomical Therapeutic Chemical J01 group), recorded in medication records of patients over 18 years old, admitted from Jan 1st to March 31st 2011, were analysed. Results: A total of 2971 prescriptions were analysed. The most frequently prescribed therapeutic classes were 1st generation cephalosporins (53.7%), followed by penicillins (10.3%). Almost 90% of antibacterials were used by parenteral route. The most recurrent indication was surgical prophylaxis (65.2%). Culture-directed treatment appeared in 3.0%. Prescriptions with an unclear indication were identified (4.9%). Reason for withdrawing was unknowning 4.2% cases, in 2.8% an iv-to-oral switch occurred, and in 1.5% antibacterials were switched according to microbiological isolation. Lower respiratory tract infections were the most frequent diagnose (44.5%). The highest percentage of antibacterials prescribed for therapeutic purposes were combinations of penicillins with beta-lactam inhibitors (24.3%), 3rd generation cephalosporins (14.6%) and quinolones (14.0%). Prophylaxis was exclusively intraoperative in 54.5% cases, and was extended for more than 24 hours in 12.1%. Total antibacterial consumption was 55.01 DDD/100 bed-days. Conclusion: Targets for quality improvement of antibacterial use were identified in Hospital da Luz: abuse of parenteral route; reduced culture- irected treatments; unknown withdrawal reasons, reduced microbiological isolation and iv-to-oral switch; unclear indication; excess of broad-spectrum antibacterials; prophylaxis duration over 24 hours.
Descrição
Tese de mestrado, Doenças Infecciosas Emergentes, Faculdade de Medicina, Universidade de Lisboa, 2012
Palavras-chave
Antibióticos Consumo Vigilância Teses de mestrado - 2012