Análise de um programa de gestão de antimicrobianos em unidade de terapia intensiva pediátrica

Abstract

Summary: Antimicrobials have been oftentimes excessively prescribed, promoting the emergence and expansion of antibiotic resistant organisms. Bacterial resistance is a considerable public health problem, since it reduces the ability of infectious disease prevention and treatment. In this scenario, the antibiotic stewardship programs (ASPs) arise as a key intervention in order to optimize the use of these drugs contributing to reduce bacterial resistance rates. Objective: Assess an antibiotic stewardship program in newborn and pediatric intensive care units (ICU) by comparing hospital-acquired infection (HAI) rates, bacterial resistance rates and HAI causative agents in the year of complete deploy and after its deployment. Restricted use antimicrobial requests have also been analyzed. Methodology: Two methodologies have been applied: 1) a before and after intervention semi experimental study for assessing HAI rates and bacterial resistance rates and 2) retrospective and prospective descriptive study for antimicrobial requests analysis. Results: We admitted 551 patients in NICU and 1,154 in PICU. The HAI rate in newborn ICU was (21/284) 7.4% in 2016 and (16/267) 6% in 2017 (22% decrease in absolute quantitative cases, p=0.5) and in the pediatrics ICU was (50/578) 8.7% in 2016 and (39/576) 6.8% in 2017 (23.8% decrease in absolute quantitative cases, p=0.2). The percent of positive cultures in HAI cases was 61.9 in 2016 and 61.8 in 2017 (p=0.8). The average length of stay in newborn ICU after each HAI episode was 128 days in 2016 and 59 days (95% CI 30 - 88) in 2017 (p=0.01). After 30-days HAI had been diagnosed, 13 (61.9%) patients remained hospitalized in newborn ICU in 2016 and 2 (12,5%) in 2017 (p=0,007). The average length of stay in pediatric ICU after each HAI episode was 128 days (CI 95% 94 - 163) in 2016 and 97 days (IC 95% 68 - 126) in 2017 (p=0,18). The resistance rates found in nosocomial infection causative bacteria in the newborn ICU was 36.4% (4/11) in 2016 and 66.7% (4/6) in 2017 and in pediatric ICU was 44.4% (12/27) in 2016 and 47.4% (9/19) in 2017. During the period of October 2016 and December 2017, 120 restricted use antimicrobials requests have been issued in the newborn and pediatric ICU, and cultures had been collected before the antimicrobial initiation in 98 cases, with a positivity of 53% (n=52). The restricted use antimicrobial request approval rate has been 92.5%. Conclusion: The study showed a reduction in HAI rates in newborn and pediatric ICU, in absolute quantitative, after a deployment of ASP, length of stay reduction, reduction in absolute number of multiresistant bacteria causing HAI, high positive culture in patients for whom there has been request of antimicrobial and excellent rates of requests approval. It is suggested to maintain the practices implemented for long periods in order to obtain even expressive results