Objetivos: Avaliar o perfil de uso de antimicrobianos na unidade de terapia intensiva (UTI), após implementação do Antimicrobial Stewardship Program (ASP). Métodos: estudo do tipo antes e depois da implementação do programa, realizado de janeiro a dezembro de 2018, envolvendo pacientes com mais de 18 anos, que estiveram internados na UTI, com solicitação de análise microbiológica para apoio diagnóstico de infecção presumida ou confirmada e em uso de antimicrobianos. Foram comparados os resultados dos períodos anterior e posterior à implantação do ASP (1º semestre/2018 versus 2º semestre/2018). Os dados secundários foram obtidos por meio de prontuários e software da unidade de estudo. Foi feita a caracterização da distribuição dos pacientes e monitoradas as variáveis: DDD/1000 pacientes-dia, internados na UTI, número de solicitações de tratamento, média de uso de antimicrobianos por paciente e proporção do consumo de antibióticos, obedecendo à categorização AWaRe. Para análise estatística, foram utilizados os testes t-Student com variâncias desiguais, t-Student com variâncias iguais e teste Mann-Whitney. Resultados: No total, 461 pacientes foram incluídos no estudo. Observou-se que o meropenem foi o antimicrobiano com maior DDD/1000 pacientes-dia em ambos os semestres avaliados (696,67 ± 120,95 versus 481,08 ± 145,23), seguido da vancomicina (316,50 ± 59,89 versus 311,71 ± 89,52). No período pós-intervenção do ASP, houve redução significativa da DDD/1000 pacientes-dia para os antibióticos Meropenem (p = 0,020) e Polimixina B (p = 0,007) e aumento para Piperacilina/Tazobactam. Observou-se um total de 1.605 solicitações de tratamento antimicrobiano em 2018, com redução significativa após intervenção do ASP (147,50 ± 16,63 versus 120,00 ± 18,34, p = 0,022). Considerando a classificação AWaRe, os antibióticos mais utilizados em 2018, em ambos os semestres, corresponderam aos de “Vigilância” (64%), seguidos dos classificados como “Reserva” (21%) e por fim, os de “Acesso” (15%). Conclusões: os resultados apontaram a redução do uso de antimicrobianos, especialmente de antibióticos de amplo espectro, após a intervenção do ASP, o que era esperado, visto que esta é uma ferramenta importante no manejo da terapia antimicrobiana em pacientes acometidos por infecção em unidade de cuidados críticos.
BACKGROUNDTo analyze patients profile diagnosed with Vogt-Koyanagi-Harada syndrome (VKHS) in a joint outpatient clinic for rheumatology and ophthalmology at a tertiary hospital, as well as the proposed treatment and its effectiveness.
BACKGROUNDSystemic lupus erythematosus (SLE) is a chronic, multisystemic, immune-mediated disorder associated with a substantial hospitalization risk. The studies on frequency and causes of hospitalizations are conflicting. We aim to describe causes and rates of hospitalization for SLE patients in a tertiary reference hospital. METHODSThis cross-sectional retrospective study evaluated SLE patients aged 18-65 years and admitted to infirmaries from January 2014 to December 2020. Medical records were revised for demographic, clinical and laboratory characteristics, previous and ongoing treatments and the reason for admission. RESULTSWe included 452 patients. The mean age was 37 years, and 88% were females. Except for 7.5% newly diagnosed SLE, all patients were in use of immunosuppressive drugs (azathioprine, methotrexate or cyclophosphamide) and glucocorticoids up to 1 mg/kg/day of prednisone or equivalent. Flare (or active disease) of SLE was the most common cause of hospitalization (44%), followed by infection (24%) and treatment with intravenous drugs (16%). Approximately 3.5% of patients were admitted for gynecological or obstetric reasons, and 1.5% for treatment of manifestations related to antiphospholipid antibody syndrome. Other causes contributed for 10% of admissions. Flares were due to renal (14%), more than one organ or system (12%), central and peripheral nervous system (8%), hematologic (2.5%), pulmonary (2%), cardiac (1.5%), blood vessels (1%), serosa (1%), joint (0.9%) and skin (0.6%) involvement. CONCLUSIONFlare was the most common reason for hospital admission in SLE, which matches previously published studies. Kidneys were the most frequently affected organ, which is consistent with previous reports. Infection was the second most frequent cause of hospitalization, and may be related to the disease itself, associated comorbidities or immunosuppressive therapy. Manifestations of the disease were the main cause of hospitalizations in SLE. Infections presented as another important cause of need for hospital care, which can be at least in part attributed to immunosuppressive therapy.
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