Padrões de utilização de antibacterianos em três unidades de terapia intensiva do Distrito Federal

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

To know the patterns of use of antibacterial agents in the intensive care units (ICU) of the Federal District have been conducted two studies. The first study was retrospective and it was done in a private hospital, from January 2001 to June 2004. There used aggregate data from the electronic files of the hospital pharmacy and all 2890 patients admitted to the ICU during the period were considered. It this study was found that each patient hospitalized in the ICU used, on average, 1.9 DDD (defined daily dose) of antibacterial per day of hospitalization. During the period studied, the overall rate of consumption of antibacterial not changed significantly (p = 0.151). However, there was significant change in the rates of consumption of two groups of antibacterial: there was increase in the consumption of penicillin / inhibitors of betalactamases, from 306.6 DDD/1000 patients-day (DDD1000) in 2001, to 686.5 DDD1000 in 2004 (p = 0.002), and reduction in the consumption of glycopeptides from 146.1 DDD1000, in 2001, to 70.3 DDD1000 in 2004 (p = 0.001). The most widely used antibacterial belonged to groups of penicillin / inhibitors of betalactamases, 3rd generation cephalosporins, quinolones and carbapenemics. Both, the overall rates of consumption of antibacterial and the rates of the groups of antibacterial used mainly in cases of infections acquired in the ICU (3rd generation cephalosporins, quinolones, carbapenemics and glycopeptides), showed significantly correlation with the overall rates of hospital infection and with the ratio of the use of the risk procedures for hospital infection. The only exception was the group of carbapenemics, whose rates of consumption is not associated with indicators of hospital infection. The second study was prospective. It was done in three ICU, chosen for convenience: two in public institutions (Regional Hospital of Ceilândia - HRC and Regional Hospital of Taguatinga - HRT) and one in private hospital (Santa Luzia Hospital - HSL). The period of coverage of the study was from 01/10/2004 to 30/09/2005. Simple random sample of patients admitted in each of the three ICU were used and the numbers of patients included were 53 (HRC), 40 (HRT) and 103 (HSL). Data were colleted relating to patients and to units such as age, sex, origin, type of patient, severity, and mortality, and data relating to the consumption of antibacterial, the indicators of hospital infections and the bacterial antimicrobial sensitivity. It was revealed that patients and the ICU of the public hospitals had been similar in many features, except the rate of infection of the current blood, significantly higher in the ICU of the HRT (12.13 casos/1000 catheters central-day) than in the ICU of the HRC (2.83 casos/1000 catheters central-day). Moreover, there was significant difference between the ICU of the public hospitals and the private hospital on the following aspects: 1) The proportion of the clinical patients was greater in the public hospitals; 2) The patients admitted in public hospitals have mainly from other hospitals while those in the private hospital were from the surgical room of the hospital, and 3) The score of gravity, the ratio of the use of procedures for risk for hospital infections, the proportions of patients who used antibacterial, the permanence time and the rates of mortality patients were higher in public hospitals than in private hospitals. Although the rate of consumption of antibacterial in the ICU of the hospital private (2191.7 DDD1000) was significantly higher than in public hospitals (HRC: 1661.2 DDD1000; HRT: 1383.3 DDD1000, p <0.001), the antibacterial groups most consumed were similar in the three ICU (penicillin / inhibitors of betalactamases, 3rd generation cephalosporins, quinolones and carbapenemics). Similarly, as could be judged, was similar to the profile of bacterial resistance in the three units. It follows that the rates of consumption of antibacterial analyzed in ICU are in the broad range observed in ICU from various parts of the world, except the rate of consumption in the private hospital, which was above the percentile 90. In addition, the antibacterial most used, in general, are of broad or intermediary spectrum. These suggest that the use of antibacterial exerts strong selective pressure on the environment of the ICU evaluated.

ASSUNTO(S)

epidemiologia epidemiologia agentes antibacterianos unidades de terapia intensiva agentes antibacterianos/utilização

ACESSO AO ARTIGO

Documentos Relacionados