Caracterización de un programa de optimización de tratamiento antimicrobiano en una institución hospitalaria de IV nivel de Bogotá Colombia entre 2015 2018
Thesis
The purpose of the Antimicrobial Stewardship is to evaluate and strengthen the appropriate use of antimicrobials, through knowledge and education to select the optimal regimen that provides better clinical outcomes, fewer adverse events, and leads to hospital infection control, lower rates of antimicrobial resistance and reduce health costs. It is important to generate epidemiological studies that provide data on Antimicrobial Stewardship interventions and thus evaluate their performance. Objectives: Describe the main characteristics of an Antimicrobial Stewardship in patients treated by different medical services and with infectious pathologies in high level of care hospital institution in Bogotá – Colombia. Methods: Observational, descriptive and retrospective cross-sectional study. Data obtained from medical records. Data collection will be carried out for the years 2015 to 2018. The population was composed of patients over 18 years of age hospitalized for infectious pathologies that required antimicrobial treatment. Results: Data were obtained from the medical records of 10,886 patients, of which 9,379 were analyzed. The average age was 65.5 years (standard deviation 18,1 years), 4,964 (53.1%) were women. The most frequent diagnosis was urinary tract infection (UTI) 21%, followed by pneumonia/empyema 15.4%. 81.1% of the recipes are considered well formulated. Piperacillin tazobactam the most frequently formulated antibiotic 41%. 15.6% of suspected healthcare-associated infections (HAIs) are described. The average time to antimicrobial de-escalation (ADE) did not exceed 3.1 days (standard deviation 2,2 days). The percentage of interventions due to infectious disease specialists (modification or suspension of therapy) was between 53.5% and 59.7% during the years of the study. There was a reduction in the average number of days scheduled for treatment by the years of the study, 2016: 11 days in contrast to 2018: 6 days. Conclusions: The most frequent infections that involve hospital care and antimicrobial prescription are urinary tract infection (UTI), pneumonia/empyema, Appendicitis/peritonitis/intra-abdominal abscess, Septic shock/sepsis of focus to be clarified. The most frequently prescribed antimicrobial for these infections are: piperacillin tazobactam, vancomycin, meropenem, ertapenem and ceftriaxone. A significant percentage of patients with antimicrobial treatment had correct formulations, and even in these cases the prescription can be optimized. Optimization can be done based on management guides or the preparation and analysis of microbiological reports by an Antimicrobial Stewardship.
