Stewardship of antimicrobials in an intensive care unit during the COVID-19 pandemic in a private hospital
DOI:
https://doi.org/10.33448/rsd-v11i12.31965Keywords:
Antimicrobial; Pharmacoeconomics; Health care.Abstract
Antimicrobial management is one of the clinical pharmacist's tools. COVID-19 was one of the great challenges for the entire multiprofessional team, since the pandemic directly affected the tertiary health system, generating impacts in the world in relation to antimicrobial therapy. The role of the pharmaceutical pharmacist is necessary to ensure safety in the rationality of medicines and to contribute to the reduction of antimicrobial resistance and rational use. The objective of the study was related to the follow-up of the clinical pharmacist in patients with a positive diagnosis for COVID-19, supported in an intensive care unit, from March to June 2020, in a private hospital in Campo Grande, Mato Grosso do Sul. It was a descriptive, observational approach study. For data collection, a specific research form was used, filled out from the patient's records. Fifty eight patients participated, being 72.41% male, with a mean age of ±61.01 years. There were 10 pharmaceutical interventions related to prescription, being the most frequent treatment time adjustment (17.44% and 30% of treatment), a cost optimization of 81%, a cost optimization of R$25.195,76. The study concludes that the COVID-19 pandemic was a milestone in health care in general, especially regarding the role of the clinician in the monitoring of antimicrobial therapy, with emphasis on the intensive care unit.
References
Abelenda-Alonso, G.; et al (2020). Antibiotic prescription during the COVID-19 pandemic: A biphasic pattern. Infection Control and Hospital Epidemiology, 41(11), 1371–1372.
de Abreu, J. A. C., Silva, F. B. A. (2021). Uma “espada-de-dois-gumes”: bactérias & Covid-19. Brazilian Journal of Development, 7(5), 53750-53769.
Agência Nacional de Vigilância Sanitária – ANVISA (2021). Nota Técnica GVIMS/GGTES/ANVISA N° 06/2021 – Implementação do Programa de Gerenciamento do Uso de Antimicrobianos (PGA) pelos hospitais. Brasília, 10 de dez.
Agência Nacional de Vigilância Sanitária – ANVISA (2017). Diretriz Nacional para Elaboração de Programa de Gerenciamento do Uso de Antimicrobianos em Serviços de Saúde. Brasília, 28 de dez.
Brooke, J. S. Stenotrophomonas maltophilia: an emerging global opportunistic pathogen. Clin Microbiol Rev, 25(1):2-41. 2012
Cantón, R., Gijón, D., Ruiz-Garbajosa, P. Resistência antimicrobiana em UTIs: uma atualização à luz da pandemia de COVID-19, Opinião Atual em Cuidados Críticos: v. 26, ed. 5, p. 433-441.
Centre for Disease Control and Prevention (CDC). SARS-CoV-2 Variant Classifications and Definitions Updated, 2021. Disponível em: https://www.cdc.gov/coronavirus/2019-ncov/casesupdates/variant-surveillance/variant-info.html Acesso em: 13 jun. de 2022
Chen, N., et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet, 2020, v. 395, p.507-13.
Clancy, C. J.; Nguyen, M. H. COVID-19, superinfections and antimicrobial development: What can we expect? Clinical Infectious Diseases, v. 71, n. 17, p. 2736-2743, 2020.
Fang, X., et al. Epidemiological, comorbidity factors with severity and prognosis of COVID-19: a systematic review and meta-analysis. Aging (Albany NY), 13;12(13):12493-503. 2020
Cheng, K., et al. Analysis of the Risk Factors for Nosocomial Bacterial Infection in Patients with COVID-19 in a Tertiary Hospital. Risk Management and Healthcare Policy, 2020; 13: 2593–2599
Feldman C, Anderson R. The role of co-infections and secondary infections in patients with COVID-19. Pneumonia, 2021;13(1): 5.
Fernandes, T. P, et al. Infecções secundárias em pacientes internados por COVID-19: consequências e particularidades associadas. REAC, 2021, v. 34
Gomes, G. G. C., et al. Estudo epidemiológico transversal sobre as hospitalizações por Síndrome Respiratória Aguda Grave causada pela COVID-19 no Brasil. InterAm J Med Health, 2021; 4:e202101008
Jeffrey, M., et al. Utility of Tracheostomy in Patients with COVID ‐19 and Other Special Considerations. The Laryngoscope, 2020.
Hsu, J. How covid-19 is accelerating the threat of antimicrobial resistance. BMJ, v. 369, 2020.
Langford, B. J., et al. Bacterial co-infection and secondary infection in patients with COVID19: a living rapid review and meta-analysis. Clinical Microbiology and Infection, 26:1622-1629. 2020.
Lauring A S. Genetic Variants of SARS-CoV-2—What Do They Mean? JAMA. February 9, 2021. 325(6): 529-31
Levinson, W. Microbiologia médica e imunologia. 10. ed. – Porto Alegre: AMGH, 2011.
Looney, W. J., Narita, M., Mühlemann, K. Stenotrophomonas maltophilia: an emerging opportunist human pathogen. Lancet Infect Dis, 9:312. 2009
Malcolm, W.; et al. Impact of the COVID-19 pandemic on community antibiotic prescribing in Scotland. JAC-Antimicrobial Resistance, v. 2, n. 4, 2020.
Mascarello, K. C., et al. Hospitalização e morte por COVID-19 e sua relação com determinantes sociais da saúde e morbidades no Espírito Santo: um estudo transversal. Epidemiol. Serv. Saude, Brasília, 2021, 30(3):e2020919.
Murray, P. R., Rosenthal, K. S., Pfaller, M. A. Microbiologia Médica. 7. Ed.- Rio de Janeiro: Elsevier, 2014.
Nicodemo, A. C., Paez, J. I. Antimicrobial therapy for Stenotrophomonas maltophilia infections. Eur J Clin Microbiol Infect Dis, 26(4):229-37. 2007.
Nyc, O., Matejková, J. Stenotrophomonas maltophilia: Significant contemporary hospital pathogen - review. Folia Microbiol (Praha), 55(3):286-94. 2010
Organização Mundial Da Saúde (OMS). COVID-19 Clinical management: living guidance. 2021. Disponível em: <https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-1>.Acessado em: 05 mai, 2022.
Organização Pan-Americana da Saúde – OPAS. Consenso brasileiro de atenção farmacêutica: proposta Adriana Mitsue Ivama. [et al.], Brasília: 2002. 24 p
Organização Pan-Americana da Saúde (OPAS). A resistência aos antimicrobianos, fomentada pela pandemia de COVID-19. Informe de política, 2021. Disponível em: https://iris.paho.org/bitstream/handle/10665.2/55936/OPASCDEAMRCOVID19220006_por.pdf?sequence=1&isAllowed=y. Acesso em: 11 mai. 2022.
Organização Pan-Americana da Saúde (OPAS). Epidemiological update: Variants of SARS-CoV-2 in the Americas. 2021. Disponível em https://reliefweb.int/sites/reliefweb.int/files/resources/2021-jan-26-phe-epi-update-SARS-CoV-2-updated.pdf Acesso em: 13 jun. de 2022.
Pappas, P. G. et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 update by the infectious diseases society of america. Clinical Infectious Diseases, [S.L.], v. 62, n. 4, p. 1-50. 2015.
Programa de apoio ao desenvolvimento institucional do sistema único de saúde (PROADI-SUS). Projeto Impacto MR. 2021.
Rawson, T. M.; et al. Antimicrobial use, drug-resistant infections and COVID-19. Nature Reviews Microbiology, v. 18, n. 8, p. 409–410, 2020.
Rees, E. M., et al. COVID-19 length of hospital stay: a systematic review and data synthesis. BMC Med 18, 270 (2020).
Reis, W. C. T., et al. Análise das intervenções de farmacêuticos clínicos em um hospital de ensino terciário do Brasil. Einstein, 11(2):190-6, 2013.
Santis, V. D., et al. Bacterial infections in critically ill patients with SARS-2-COVID-19 infection: results of a prospective observational multicenter study. Springer Nature, X:1-10. 2021
Siqueira, L. F., Neto, L. C. G., Gonçalves, K. A. M. Atuação do farmacêutico clínico no ambito hospitalar. Brazilian Journal of Health Review, Curitiba, v.4, n.6, p. 25467-25485 nov./dec. 2021.
Vasconcelos, D. M. M., et al. Política Nacional de Medicamentos em retrospectiva: um balanço de (quase) 20 anos de implementação. Ciên. Saúde Colet. 22(8):2609-2614, 2017.
Vidal, C. G., et al. Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study. Clinical Microbiology and Infection,27: 83-88. 2021
Vicente, A. de O., Sant’ana, J. P. E., Sardenberg, R. A. da S. COVID-19 e Traqueostomia. ULAKES J Med, 1 (EE) 151-157. 2020.
Trabulsi, L. R., Alterthum, F. Microbiologia. 6. Ed – São Paulo: Atheneu, 2015.
Travis, S., et al. Tracheostomy Considerations during the COVID-19 Pandemic. American Academy of Otolaryngology-Head and Neck Surgery, 2020.
World Health Organization (WHO). News Room. and events. Antibiotic resistance. 2020. Disponível em: <https://www.who.int/news-room/fact-heets/detail/antibioticresistance>. Acesso em: 10 mai. 2022.
World Health Organization (WHO). Medication Without Harm – Global patient Safety Challenge on Medication safety. Geneva: World Health Organization, 2017.
World Health Organization (WHO). WHO policy guidance on integrated antimicrobial stewardship activities. Geneva: World Health Organization; 2021.
Zhang, C., Shi, L., Wang, F. S. Liver injury in COVID-19: management and challenges. Lancet - Gastroenterol Hepatol, 2020; 5:428-30.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Nathália Franco Roriz; Isadora Padilha Ribolis; Janaína Matias dos Santos; Haydee Marina do Valle Pereira; Danielle Bogo; João Ricardo Filgueiras Tognini; Rita de Cássia Avellaneda Guimarães
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.