IMPLICATIONS OF ANTIMICROBIAL STEWARDSHIP IN A PUBLIC HOSPITAL
DOI:
https://doi.org/10.54620/cadesp.v18i1.1936Keywords:
Health Management, Health Strategies, Public HospitalsAbstract
To describe the clinical and financial implications of the strategies of an Antimicrobial Stewardship Programme (AMP) in the adult and paediatric wards and Intensive Care Units (ICUs) of a public hospital in the state of Ceará. This was a prospective, descriptive and quantitative study of the implications of the recommendations made by the AMP team between June and October 2023. Data was collected from electronic medical records and patient files monitored by the programme. The clinical significance, acceptability rate and minimised cost of the recommended strategies were analysed. 1165 recommendations were made in 553 patients, with stopping treatment (25.24%) being the most common type of recommendation, followed by dose adjustment (22.83%). Reducing unnecessary exposure to antimicrobials (42.40 per cent) and increasing treatment efficacy (32.79 per cent) stood out as the most common clinical impacts. Recommendations were the most important in 50.47 per cent of cases. The minimising strategies resulted in net cost savings of approximately R$115,843.75. The team's recommendations had a positive influence on both the clinical and financial results of antimicrobial use.
Downloads
References
Hofer U. The cost of antimicrobial resistance. Nature Reviews Microbiology. 1º de janeiro de 2019;17(1):3–3. DOI: 10.1038/s41579-018-0125-x DOI: https://doi.org/10.1038/s41579-018-0125-x
World Health Organization, B. (2019). No time to wait: securing the future from drug-resistant infections. Report to the Secretary-General of the United Nations. Interagency Coordination Group on Antimicrobial Resistance. [online]. Disponível em: https://www.who.int/publications/i/item/no-time-to-wait-securing-the-future-from-drug-resistant-infections
Dellit TH, Owens RC, McGowan JE, Gerding DN, Weinstein RA, Burke JP, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship. Clinical Infectious Diseases. 2007 Jan;44(2):159–77. DOI: 10.1086/510393 DOI: https://doi.org/10.1086/510393
Gross R, Morgan AS, Kinky DE, Weiner M, Gibson GA, Fishman NO. Impact of a Hospital-Based Antimicrobial Management Program on Clinical and Economic Outcomes. Clinical Infectious Diseases. 2001 Aug;33(3):289–95. DOI: 10.1086/321880 DOI: https://doi.org/10.1086/321880
Karanika S, Paudel S, Grigoras C, Kalbasi A, Mylonakis E. Systematic Review and Meta-analysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs. Antimicrobial Agents and Chemotherapy. 2016;60(8):4840–52. DOI: 10.1128/aac.00825-16 DOI: https://doi.org/10.1128/AAC.00825-16
Paterson DL. The Role of Antimicrobial Management Programs in Optimizing Antibiotic Prescribing within Hospitals. Clinical Infectious Diseases. 2006 Jan;42(Supplement_2):S90–5. DOI: 10.1086/499407 DOI: https://doi.org/10.1086/499407
Huaguang Wang, Han Wang, Xiaojia Yu, Hong Zhou, Boyu Li, Gang Chen, et al. Impact of antimicrobial stewardship managed by clinical pharmacists on antibiotic use and drug resistance in a Chinese hospital, 2010–2016: a retrospective observational study. BMJ Open. 2019 Aug 1;9(8):e026072. DOI: 10.1136/bmjopen-2018-026072 DOI: https://doi.org/10.1136/bmjopen-2018-026072
Salman B, Al-Hashar A, Al-Khirbash A, Al-Zakwani I. Clinical and Cost Implications of Clinical Pharmacist Interventions on Antimicrobial Use at Sultan Qaboos University Hospital in Oman. International Journal of Infectious Diseases. 2021;109:137–41. DOI: 10.1016/j.ijid.2021.07.002 DOI: https://doi.org/10.1016/j.ijid.2021.07.002
de Programa, E. D. P. E. Diretriz Nacional para Diretriz Nacional para Elaboração de Programa Elaboração de Programa de Gerenciamento de Gerenciamento de Antimicrobianos em Antimicrobianos em Serviços de Saúde Serviços de Saúde. Disponível em: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/publicacoes/DiretrizGerenciamentoAntimicrobianosANVISA2023FINAL.pdf8.
Spinewine A, Dhillon S, Mallet L, Tulkens PM, Wilmotte L, Swine C. Implementation of ward-based clinical pharmacy services in Belgium--description of the impact on a geriatric unit. Ann Pharmacother. 2006;40(4):720-728. DOI:10.1345/aph.1G515 DOI: https://doi.org/10.1345/aph.1G515
Gavazzi G, Krause KH. Ageing and infection. The Lancet Infectious Diseases. 2002 Nov 1;2(11):659–66. DOI: 10.1016/S1473-3099(02)00437-1 DOI: https://doi.org/10.1016/S1473-3099(02)00437-1
Stewart S, Robertson C, Pan J, Kennedy S, Haahr L, Manoukian S, et al. Impact of healthcare-associated infection on length of stay. Journal of Hospital Infection. 202;114:23–31. DOI: 10.1016/j.jhin.2021.02.026 DOI: https://doi.org/10.1016/j.jhin.2021.02.026
O'Keefe S, Williams K, Legare JF. Hospital-Acquired Infections After Cardiac Surgery and Current Physician Practices: A Retrospective Cohort Study. J Clin Med Res. 2017;9(1):10-16. DOI:10.14740/jocmr2637w. DOI: https://doi.org/10.14740/jocmr2637w
Busch LM, Kadri SS. Antimicrobial Treatment Duration in Sepsis and Serious Infections. The Journal of Infectious Diseases. 2020 Jul;222(Supplement_2):S142–55. DOI: 10.1093/infdis/jiaa247 DOI: https://doi.org/10.1093/infdis/jiaa247
Retamar P, Portillo MM, López-Prieto MD, Rodríguez-López F, Cueto M de, García MV, et al. Impact of Inadequate Empirical Therapy on the Mortality of Patients with Bloodstream Infections: a Propensity Score-Based Analysis. Antimicrobial Agents and Chemotherapy. 2012;56(1):472–8. DOI: 10.1128/aac.00462-11 DOI: https://doi.org/10.1128/AAC.00462-11
Altaf U, Saleem Z, Akhtar MF, Altowayan WM, Alqasoumi AA, Alshammari MS, Haseeb A, Raees F, Imam MT, Batool N, et al. Using Culture Sensitivity Reports to Optimize Antimicrobial Therapy: Findings and Implications of Antimicrobial Stewardship Activity in a Hospital in Pakistan. Medicina. 2023; 59(7):1237. DOI:10.3390/medicina59071237 DOI: https://doi.org/10.3390/medicina59071237
Brusselaers N, Vogelaers D, Blot S. The rising problem of antimicrobial resistance in the intensive care unit. Annals of Intensive Care. 2011 Nov 23;1(1):47. DOI: 10.1186/2110-5820-1-47 DOI: https://doi.org/10.1186/2110-5820-1-47
Luyt CE, Bréchot N, Trouillet JL, Chastre J. Antibiotic stewardship in the intensive care unit. Critical Care. 2014 Aug 13;18(5):480. DOI: 10.1186/s13054-014-0480-6 DOI: https://doi.org/10.1186/s13054-014-0480-6
Al-Maliky GR, Al-Ward MM, Taqi A, Balkhair A, Al-Zakwani I. Evaluation of antibiotic prescribing for adult inpatients at Sultan Qaboos University Hospital, Sultanate of Oman. Eur J Hosp Pharm. 2018;25(4):195-199. doi:10.1136/ejhpharm-2016-001146. DOI: 0.1136/ejhpharm-2016-001146 DOI: https://doi.org/10.1136/ejhpharm-2016-001146
Jéssica Moreira dos Santos M, Márcio Machado Batista J. FARMACÊUTICO CLÍNICO NO CUIDADO À SAÚDE NO HOSPITAL PÚBLICO. 2023;17:1097. DOI: https://doi.org/10.54620/cadesp.v17i1.1097
Ghamrawi RJ, Kantorovich A, Bauer SR, et al. Evaluation of Antimicrobial Stewardship–Related Alerts Using a Clinical Decision Support System. Hospital Pharmacy. 2017;52(10):679-684. DOI:10.1177/0018578717726869 DOI: https://doi.org/10.1177/0018578717726869
Zaal RJ, den Haak EW, Andrinopoulou ER, van Gelder T, Vulto AG, van den Bemt PMLA. Physicians’ acceptance of pharmacists’ interventions in daily hospital practice. International Journal of Clinical Pharmacy. 2020 Feb 1;42(1):141–9. DOI: 10.1007/s11096-020-00970-0 DOI: https://doi.org/10.1007/s11096-020-00970-0
Downloads
Published
How to Cite
Conference Proceedings Volume
Section
Categories
License
Copyright (c) 2024 Cadernos ESP

This work is licensed under a Creative Commons Attribution 4.0 International License.
Accepted 2024-04-02
Published 2024-09-13