Abstract
BackgroundAccording to the literature, 25% to 50% of antimicrobials prescribed in hospitals are unnecessary or inappropriate, directly impacting antimicrobial resistance. Thus, the present study aimed to evaluate the use of antimicrobials in a university hospital in Northeast Brazil, using days of therapy (DOT) and length of therapy (LOT) indicators in accordance with the latest national and international recommendations for monitoring the use of antimicrobials.MethodsThis is an observational, prospective analytical study conducted in a teaching hospital, with 94 active beds, distributed between the intensive care unit (ICU), the surgical clinic (SUR), the medical clinic (MED), the pneumology/infectology department (PNE/INF) and pediatrics (PED). The duration of the study was from the beginning of January to the end of December 2018.ResultsDuring the study period, a total of 11,634 patient-days were followed up and 50.4% of the patients were found to have received some antimicrobial, with a significant reduction in use of 1% per month throughout the year. Patients were receiving antimicrobial therapy for 376 days in every 1000 days of hospitalization (LOT = 376/1000pd). Overall, the 1st-generation cephalosporins and fluoroquinolones were the most used in respect of the number of prescriptions and the duration of therapy. The calculated global DOT/LOT ratio showed that each patient received an average of 1.5 antimicrobials during the hospital stay. The incidence of antimicrobial resistance, globally, for both methicillin-resistant Staphylococcus aureus (methicillin R), Carbapenem-resistant Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii (Carbapenem R), was 1 per 1000 patient-days.ConclusionsThe results obtained from the analyses revealed that half of the patients admitted to the hospital who took part in the study were exposed to the use of antimicrobials at some point during their stay. Although moderate, it is noteworthy that there was a decline in the use of antimicrobials throughout the year. The indicators used in this study were found to be very effective for gathering data on the use of antimicrobials, and assessing the results of the initiatives taken as part of the Stewardship program.
Highlights
According to the literature, 25% to 50% of antimicrobials prescribed in hospitals are unnecessary or inappropriate, directly impacting antimicrobial resistance
The intensive care unit was the ward that contained the largest proportion of patients using ATM (86%; ICU vs surgical clinic (SUR), medical clinic (MED); p = 0.000), followed by pediatrics (64%; PED vs SUR; p = 0.002) and the pneumology/infectology department (62%; pneumology/ infectology department (PNE/INF) vs SUR; p = 0.005) (Table 1)
The medical clinic had a higher number of prescriptions of 3rd generation cephalosporins (14.8%; MED vs SUR, p = 0.036; MED vs ICU, p = 0.002), the pneumology/ infectology department had a higher number of antifungals (16.0%; PNE/INF vs SUR, PED; p = 0.000) and the ICU had the most prescriptions of carbapenems (19.6%; ICU vs SUR, PED; p = 0.000) (Table 1)
Summary
25% to 50% of antimicrobials prescribed in hospitals are unnecessary or inappropriate, directly impacting antimicrobial resistance. Diagnostic uncertainty, the incorrect choice of medications, improper treatment duration, the presence of complex comorbidities, the incorrect interpretation of microbial results, and a lack of surveillance to monitor the use of antimicrobials are the main factors that are responsible for the inappropriate use of these drugs [5, 7, 8] In response to this growing problem, the Centers for Disease Control and the World Health Organization, together with the United Nations member countries, including Brazil, have been encouraging the implementation of antimicrobial stewardship programs (ASPs), which are a set of interventions, audits, and feedback, to optimize the use of ATMs [2, 3, 9, 10]. The DOT/LOT ratio can be useful to assess the number of antimicrobials prescribed per patient, with a ratio of 1 representing monotherapy, and a ratio of > 1 representing combination therapy [1, 3, 9, 11, 12]
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