Terapia antimicrobiana seqüencial: impacto de uma intervenção na adesão em um hospital universitário do Brasil

Abstract

In hospitals, usually occur unnecessarily prolonged the use of intravenous (IV) route during treatment with antibiotics. This tends to raise the cost of hospitalizations for both hospitals and for the patients, determining greater length of hospital stay and risk of nosocomial infection, like bloodstream infection. Whereas up here, antimicrobial therapy sequential (ATS) as the exchange of antimicrobial from IV route to oral (PO) during treatment, this practice has been recommended for the purpose of reducing this time of use of antimicrobial IV avoiding possible complications related to the venous access, which could lead to an early discharge of the patient. The objective of this study was to find the effectiveness of intervention in order to implement the ATS at an university hospital in Brazil, with consequent reduction of the time of use IV route. This was a prospective study , the type before and after, and was conducted at the Hospital de Clínicas da Universidade Federal de Uberlândia, Minas Gerais, Brazil, an university hospital of high complexity. We evaluated 117 patients in the pre-intervention (from Apr 04, 2005 to Jul 20, 2005) and 117 in the intervention (Sep 24, 2007 to Dec 20, 2007), among hospitalized in surgical wards, medical clinic wards and intensive care unit for adults. Among the pre-intervention (PPI) and intervention (IP) were prepared guidelines that were implemented in the intervening period along with other strategies like educational measures and reminder system fixed in the patient's prescription. Among the evaluated patients in the PPI and PI respectively, 72 (61.54%) and 75 (64.10%) were male and 45 (38.46%) and 42 (35.90%) were female, and the average age were 53.38 and 51.98 years old. In each period, the antibiotics were used by IV route, in each course of treatment, on average, by 14.79 and 11.75 days, respectively, and the ceftriaxone was the antibiotic most prescribed (23.44% e 21.67%, respectively). Severity of the case was one of the main justifications for the prescription of the IV route in the first period. In the PPI and PI, the length of hospitalization from the first antibiotic prescription was, on average, 21.81 and 17.45 days, respectively, considering artificially the maximum time as 60 days; the exchange of antimicrobial from IV route to PO only occurred on 4 and 5 courses of treatment, respectively. In the PPI and PI, respectively, 15 (12.82%) and 22 (18.80%) patients died and 6 (5.13%) and 5 (4.27%) remained hospitalized for more than 60 days. We conclude that sequential antimicrobial therapy is rarely used and the proposed intervention is ineffective in order to implement it.