Using point prevalence survey to define burden of antimicrobial use among 35 adult intensive care units in Brazil

Braga, Iolanda Alves; Campos, Paola Amaral de; Batistão, Deivid William da Fonseca; Filho, Paulo Pinto Gontijo; Ribas, Rosineide Marques

doi:10.1080/23744235.2019.1581371

Cited by 5 publications

(6 citation statements)

References 7 publications

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“…We were specifically interested in the indirect impact of antimicrobial use on the incidence of CR-GNB, which are hyperendemic in ICUs in Brazil. 16,17 As expected, 18 we found not only a massive use of carbapenems but also a relevant incidence of CR-GNB, even among patients to whom carbapenems were not prescribed.…”

Section: Discussionsupporting

confidence: 85%

Acquisition of carbapenem-resistant gram-negative bacilli among intensive care unit (ICU) patients with no previous use of carbapenems: Indirect population impact of antimicrobial use

Oliveira

Sampaio

Leite

et al. 2022

Infect. Control Hosp. Epidemiol.

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Objective: To measure the impact of exposure to patients using carbapenem on the acquisition of carbapenem-resistant gram-negative bacilli (CR-GNB) among patients not using carbapenems. Design: An ecological study and a cohort study. Setting: Two medical surgical intensive care units (ICUs) in inner Brazil. Participants: Patients admitted to 2 ICUs from 2013 through 2018 to whom carbapenem was not prescribed. Methods: In the ecologic study, the monthly use of carbapenems (days of therapy [DOT] per 1,000 patient days) was tested for linear correlation with the 2-month moving average of incidence CR-GNB among patients to whom carbapenem was not prescribed. In the cohort study, those patients were addressed individually for risk factors (demographics, invasive interventions, use of antimicrobials) for acquisition of CR-GNB, including time at risk and the “carbapenem pressure,” described as the aggregate DOT among other ICU patients during time at risk. The analysis was performed in univariate and multivariable Poisson regression models. Results: The linear regression model revealed an association of total carbapenem use and incidence of CR-GNB (coefficient, 0.04; 95% confidence interval [CI], 0.02–0.06; P = .001). In the cohort model, the adjusted rate ratio (RR) for carbapenem DOT was 1.009 (95% CI, 1.001–1.018; P = .03). Other significant risk factors were mechanical ventilation and the previous use of ceftazidime (with or without avibactam). Conclusions: Every additional DOT of total carbapenem use increased the risk of CR-GNB acquisition by patients not using carbapenems by nearly 1%. We found evidence for a population (“herd effect”-like) impact of antimicrobial use in the ICUs.

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Section: Discussionsupporting

confidence: 85%

Acquisition of carbapenem-resistant gram-negative bacilli among intensive care unit (ICU) patients with no previous use of carbapenems: Indirect population impact of antimicrobial use

Oliveira

Sampaio

Leite

et al. 2022

Infect. Control Hosp. Epidemiol.

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“…Interestingly, the risk of HAP is directly correlated with the severity of patients' immune alterations including: (1) the degree of decreased expression of human leukocyte antigen-DR (HLA-DR) on circulating monocytes (surrogate marker of a decreased antigenic presentation Rosenthal et al 2003;Ortíz et al 2014;Murni et al 2015;Iwuafor et al 2016;Mitharwal et al 2016;Phu et al 2016;Taylor et al 2016;Yakovlev et al 2016;Yallew et al 2016;Chiang et al 2018;Braga et al 2019). capacity) (Hotchkiss et al, 2013a); (2) increased production of immunosuppressive cytokines such as IL-10 (Roquilly et al, 2014) and (3) depletion of the T-lymphocyte repertoire (Venet et al, 2013).…”

Section: Immunosuppression Related To the Hospitalization In Icumentioning

confidence: 99%

Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies

Blot

Ruppé

Harbarth³

et al. 2022

Intensive and Critical Care Nursing

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“…Empirical antibiotic therapy may appear to be a good treatment strategy before the microbiological result is available, however, as an inappropriate therapy can lead to increased antibiotic resistance MICEK;KOLLEF, 2015;YOON;PARK;SOHN, et al 2016). This phenomenon is more marked in countries where the level of consumption and antimicrobial resistance are higher and where multidrug-resistant pathogens spread rapidly (CIORBA; ODONE; VERONESI, et al 2015;BRAGA;CAMPOS;BATISTÃO, et al 2019 therapy. The literature shows that the delay in initiating appropriate therapy may lead to a higher mortality rate (WI; RHEE; KANG, et al 2018).…”

Section: Resultsmentioning

confidence: 99%

Exploring the Staphylococcus Aureus in Patients Infected of the Tertiary-Care University Hospital: Results of the Retrospective Cohort Study

Quillici

Freitas

Brito

et al. 2021

RBM

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Objective: To establish a baseline of knowledge regarding about inappropriate therapy, virulence and resistance in a cohort of patients infected with S. aureus. Methods: Retrospective cohort study in tertiary-care university hospital was employed to evaluate the risk factors and the impact of inappropriate therapy among patients with Staphylococcus aureus infections, resistance and virulence. To assess the presence of the genes was performed PCR. Results: Patients with MRSA were older and hospitalized 17 days longer than those with MSSA infection, which were in ICU with a bloodstream infection. 50.0% received inadequate antibiotic therapy and we found virulence factors associated with MRSA (mecA, LukS, fnbB and clfA genes). Conclusion: These data show that surveillance studies related to Staphylococcus aureus infections remain essential to identify resistance and inform policy on resistance.

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Using point prevalence survey to define burden of antimicrobial use among 35 adult intensive care units in Brazil

Cited by 5 publications

References 7 publications

Acquisition of carbapenem-resistant gram-negative bacilli among intensive care unit (ICU) patients with no previous use of carbapenems: Indirect population impact of antimicrobial use

Acquisition of carbapenem-resistant gram-negative bacilli among intensive care unit (ICU) patients with no previous use of carbapenems: Indirect population impact of antimicrobial use

Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies

Exploring the Staphylococcus Aureus in Patients Infected of the Tertiary-Care University Hospital: Results of the Retrospective Cohort Study

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