Use of monitoring indicators in hospital management of antimicrobials

Abstract

Background According 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. Methods This 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. Results During 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. Conclusions The 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.

Increased Use of Antibiotics in the Intensive Care Unit During Coronavirus Disease (COVID-19) Pandemic in a Brazilian Hospital

“…We also found an increase in consumption of first-generation cephalosporins, fluoroquinolones, and carbapenems. These are already the most commonly used antibiotics in Brazil, according to a study that included data from ICUs, surgical clinics, and pediatrics from a teaching hospital in 2018 (Da Silva et al, 2021). Surgical sectors can consume more first-generation cephalosporins, as this class is used for surgical prophylaxis (Peel et al, 2019).…”

“…Antibiotic resistance is a significant public health problem and one of the greatest challenges of our time (Centers for Disease Control and Prevention, 2021a). A contributing factor to antibiotic resistance is the misuse of antibiotics in hospitals (Food and Drug Administration, 2020), an estimated 25-50% of antimicrobials prescribed in hospitals are unnecessary or inappropriate, directly impacting antimicrobial resistance (Da Silva et al, 2021). Furthermore, the ability of microorganisms to become resistant to previously susceptible drugs is superior to the capacity of the pharmaceutical industry to introduce new antimicrobials onto the market (Fair and Tor, 2014).…”

“…Although clinical experience with previous viral epidemics suggests risks of bacterial co-infection (Chung and Huh, 2015), since the beginning of the COVID-19 pandemic experts have been warning about the risks of antibiotic overuse (Centers for Disease Control and Prevention, 2021a;Rodríguez-Baño et al, 2021). In the hospital's intensive care units (ICU), the severity of the diseases treated and the multiple interventions to the patients are expected a high antimicrobial use (Da Silva et al, 2021). Therefore antimicrobial monitoring use in the case of the pandemic is crucial to identify concerning signs of misuse or overuse.…”

Educational Activities for Students and Citizens Supporting the One-Health Approach on Antimicrobial Resistance

“…Infections due to antibiotic-resistant bacteria threaten modern healthcare and the irrational use (by both professionals and final users) of important antibiotics has been reported [ 1 , 2 ]. Such activities lead to an increased risk of spreading antimicrobial resistance in microbial populations.…”

“…Such activities lead to an increased risk of spreading antimicrobial resistance in microbial populations. Moreover, the so-called ‘antimicrobials of last resort’, such as vancomycin, are becoming less effective to treat infectious diseases [ 2 , 3 ]. In this context, antimicrobial resistance must be considered as a medical emergency.…”