Erros de prescrição de antimicrobianos em pacientes com infecção de corrente sanguínea e avaliação do seu impacto na mortalidade em uma UTI adulto

Abstract

Introduction: Inappropriate initial antimicrobial therapy leads to higher mortality in patients with bloodstream infection. This study aimed to evaluate the relationship between inappropriate antibiotic therapy of bloodstream infection and hospital mortality for critically ill patients. Methods: Between January 2015 to December 2015, 167 patients with bloodstream infection were prospectively evaluated according to the presence or absence of inappropriate antibiotic therapy of infection. Hospital mortality was the main outcome variable compared between the two study groups. Results: Infected patients who received inappropriate antibiotic therapy had statistically more diabetes mellitus, chronic obstructive pulmonary disease, chronic renal disease and death than infected patients who initially received appropriate antibiotic therapy. Loading dose error and error in starting antibiotic administration were the most frequently detected error in our study and both were determinant factors related to increased mortality. Initial antibiotic therapy was maintained, escalation and deescalation 67.6%, 22.7% and 9.6% of cases, respectively. There was statistically significant correlation between death and cases in which treatment was de-escalation (p=0.001), half of these were considered prescription errors. Coagulase negative staphylococci represented the majority reaching 40.7% and multi-drug resistant microorganisms were detected in 27.3% of infections. There was no observed difference in mortality rates among infections caused by resistant or susceptible microorganisms. Conclusion: Loading dose error and error in starting antibiotic administration, were the most frequently detected error in our study and both were determinant factors related to increased mortality.