Implementación de un programa de uso racional de antibióticos en cuidado intensivo: ¿se pueden mejorar los resultados?

Abstract

IntroductionThe misuse of antibiotics has been associated with adverse outcomes in critically ill patients. It is possible that the implementation of a rational antibiotic use program and clinical management protocols for infections in the Intensive Care Unit (ICU) could improve outcomes.. ObjectiveTo determine if the implementation of a rational use of antibiotics program is associated with positive outcomes in the ICU. MethodsAn ambispective quasi-experimental cohort-study was carried out in 2 phases of 3 months each, separated by a period of education, between July 2016 and January 2017 in an ICU of a tertiary care centre. ResultsThe study included 78 patients, of whom 93% were diagnosed with septic shock at ICU admission. E. coli related infections were identified in 29.4% of cases, followed by Klebsiella pneumoniae in 8.5%. The rational treatment rate was higher in phase 2 compared to that of phase 1 (71% vs 65%), and the difference was statistically significant (P=.015). The ICU stay was shorter in phase 2 (4.2 vs 6.7, P=.04), and days on mechanical ventilation days were also reduced (5.7 vs 2.0, P=.03). ConclusionsThe rational use of antibiotics program implementation in critically ill patients is related with ICU stay and mechanical ventilation day reduction but not with lower mortality rates. We recommend the implementation of a multidisciplinary rational antibiotic use program in our country led by the intensivists to improve clinical outcomes in critical patients.