Assessment of Adherence to Clinical Protocols and Interface with Antimicrobial Stewardship Program
DOI:
https://doi.org/10.26694/repis.v8i1.2565Palavras-chave:
Antimicrobial Agents, Drug Resistance, Microbial, Stewardship Program, Clinical GuidelinesResumo
Introduction: Antimicrobial resistance is a global concern. Antimicrobial Stewardship Program interventions are necessary to guide the implementation of treatment protocols for major infectious syndromes. Aim: To evaluate the adherence rate to clinical protocols related to the prescription of antimicrobials in a teaching hospital in Rio Grande do Sul. Outlining: Retrospective cross-sectional study, conducted with secondary data from antimicrobial prescriptions of patients hospitalized in clinical units from July to December 2020. Results: 4028 antimicrobial prescriptions were evaluated, with 42.9% non-adherence to institutional clinical protocols, 39.3% with complete adherence and 17.8% with partial adherence. Implications: Knowing the adherence data to clinical protocols provides an opportunity to intervene in improvements in antimicrobial prescribing, verifying the need for permanent education for prescribers, medical students, and residents. This contributes to the promotion of rational use of antimicrobials and helps in the fight against antimicrobial resistance.
Referências
Agência Nacional de Vigilância Sanitária. Plano Nacional para a Prevenção e o Controle da Resistência Microbiana nos Serviços de Saúde. Brasília: ANVISA [Internet]; 2017; 1–81. Available from: http://portal.anvisa.gov.br/documents/33852/271855/Plano+Nacional+para+a+Prevenção+e o+Controle+da+Resistência+Microbiana+nos+Serviços+de+Saúde/9d9f63f3-592b-4fe1-8ff2 e035fcc0f31d
Al Rahmany D, Albeloushi A, Alreesi I, Alzaabi A, Alreesi M, Pontiggia L, et al. Exploring bacterial resistance in Northern Oman, a foundation for implementing evidence-based antimicrobial stewardship program. Int J Infect Dis [Internet]. 2019 [cited 2022 Oct 8]; 83:77 82. Available from: https://doi.org/10.1016/j.ijid.2019.04.004
Yunquera-Romero L, Márquez-Gómez I, Henares-López A, Morales-Lara MJ, Gallego Fernández C, Asensi-Díez R. Adecuación de las prescripciones antimicrobianas realizadas en el área de urgencias de un hospital de tercer nivel. Rev Española Quimioter [Internet]. 2018 [cited 2022 Oct 8]; 31(3):209–16. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29771104
Nathwani D, Varghese D, Stephens J, Ansari W, Martin S, Charbonneau C. Value of hospital antimicrobial stewardship programs [ASPs]: A systematic review. Antimicrob Resist Infect Control [Internet]. 2019 [cited 2022 Oct 8]; 8(1):1–13. Available from: https://doi.org/10.1186/s13756-019-0471-0
European Commission. Antimicrobial Resistance. European Commission - EC. 2017. Available from: https://ec.europa.eu/health/amr/antimicrobial-resistance_en
Infectious Diseases Society of America. Handbook on clinical practice guideline development. IDSA. 2015. Available from: http://www.idsociety.org/uploadedFiles/IDSA/ GuidelinesPatient_Care/IDSA_Practice_Guidelines/IDSA%20Handbook%20on%20CPG%20Dev lopment%2010.15.pdf
Centers for Disease Control and Prevention. Core elements of hospital antibiotic stewardship programs. Atlanta: CDC; 2014. Available from: http://www.cdc.gov/getsmart/healthcare/pdfs/core-elements.pdf
Nathwani, D; Sneddon, J. Practical Guide to Antimicrobial Stewardship in Hospitals. BiomérieuxR. Available from: http://bsac.org.uk/wpcontent/uploads/2013/07/Stewardship Booklet-Practical-Guide-toAntimicrobial-Stewardship-in-Hospitals.pdf
Agência Nacional de Vigilância Sanitária. Diretriz Nacional para Elaboração de Programa de Gerenciamento do Uso de Antimicrobianos em Serviços de Saúde. Brasília: ANVISA; 2017. Available from: http://antigo.anvisa.gov.br/documents/33852/271855/Diretriz+Nacional+para+Elabora%C3% 7%C3%A3o+de+Programa+de+Gerenciamento+do+Uso+de+Antimicrobianos+em+Servi%C3 A7os+de+Sa%C3%BAde/667979c2-7edc-411b-a7e0-49a6448880d4?version=1.0
Pulcini C, Binda F, Lamkang AS, Trett A, Charani E, Goff DA, et al. Developing core elements and checklist items for global hospital antimicrobial stewardship programmes: a consensus approach. Clin Microbiol Infect [Internet]. 2019 [cited 2022 Oct 8]; 25(1):20–5. Available from: https://doi.org/10.1016/j.cmi.2018.03.033
Infectious Diseases Society of America. Combating antimicrobial resistance: policy recommendations to save lives. IDSA Policy Paper; 2011.
Dantas J, Porto S, Neto P, Macêdo Lima M, Fraga Lobo I. Avaliação da prescrição de antimicrobianos de uso restrito em um hospital universitário. J Infect Control. [Internet]. 2015 [cited 2022 Oct 8]; 4(2):39–48. Available from: https://jic abih.com.br/index.php/jic/article/view/82
Barlam TF, Cosgrove SE, Abbo LM, Macdougall C, Schuetz AN, Septimus EJ, et al. Implementing an antibiotic stewardship program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis [Internet]. 2016 [cited 2022 Oct 8]; 62(10):e51–77. Available from: http://dx.doi.org/10.1093/cid/ciw118
Wathne JS, Harthug S, Kleppe LKS, Blix HS, Nilsen RM, Charani E, et al. The association between adherence to national antibiotic guidelines and mortality, readmission and length of stay in hospital inpatients: Results from a Norwegian multicentre, observational cohort study. Antimicrob Resist Infect Control [Internet]. 2019 [cited 2022 Oct 8]; 8(1):1–10. Available from: http://dx.doi.org/10.1186/s13756-019-0515-5
Hagen TL, Hertz MA, Uhrin GB, Dalager-Pedersen M, Schønheyder HC, Nielsen H. Adherence to local antimicrobial guidelines for initial treatment of community-acquired infections. Dan Med J [Internet]. 2017 [cited 2022 Oct 8]; 64(6):A5381. Available from: https://pubmed.ncbi.nlm.nih.gov/28566116/
Dylis A, Boureau AS, Coutant A, Batard E, Javaudin F, Berrut G, et al. Antibiotics prescription and guidelines adherence in elderly: Impact of the comorbidities. BMC Geriatr [Internet]. 2019 [cited 2022 Oct 8]; 19(1):1–6. Available from: https://doi.org/10.1186/s12877-019-1265-1
Ament SM, de Groot JJ, Maessen JM, Dirksen CD, van der Weijden T, Kleijnen J. Sustainability of professionals’ adherence to clinical practice guidelines in medical care: a systematic review. BMJ Open [Internet]. 2015 [cited 2022 Oct 8]; ;5(12):e008073. Available from: https://doi.org/10.1136/bmjopen-2015-008073
.Phillips CJ, Gilchrist M, Cooke FJ, Franklin BD, Enoch DA, Murphy ME, Santos R, Brannigan ET, Holmes AH. Adherence to antibiotic guidelines and reported penicillin allergy: pooled cohort data on prescribing and allergy documentation from two English National Health Service (NHS) trusts. BMJ Open [Internet]. 2019 [cited 2022 Oct 8]; 9(2):e026624. doi: 10.1136 . Available from: https://doi.org/10.1136/bmjopen-2018-026624
Ferreira IER, Magalhães MKS, Albuquerque VC, Marques RB. Avaliação da adesão aos protocolos de sepse em um hospital de ensino do Piauí. R. Interd [Internet]. 2019 [cited 2022 Oct 8]; 12(4):20-31. Available from: https://dialnet.unirioja.es/servlet/articulo?codigo=7962771
Haydar SM, Hallit SR, Hallit RR, Salameh PR, Faddoul LJ, Chahine BA, Malaeb DN. Adherence to international guidelines for the treatment of meningitis infections in Lebanon. Saudi Med J [Internet]. 2019 [cited 2022 Oct 8]; 40(3):260-265. Available from: http://dx.doi.org/10.15537/smj.2019.3.23965
Sakamoto Y, Yamauchi Y, Yasunaga H, Takeshima H, Hasegawa W, Jo T, et al. Guidelines concordant empiric antimicrobial therapy and mortality in patients with severe community acquired pneumonia requiring mechanical ventilation. Respir Investig [Internet]. 2017 [cited 2022 Oct 8]; 55(1):39–44. Available from: http://dx.doi.org/10.1016/j.resinv.2016.08.006 22. Pflanzner S, Phillips C, Mailman J, Vanstone JR. AMS in the ICU: empiric therapy and aderence to guidelines for pneumonia. BMJ Open Qual [Internet]. 2019 [cited 2022 Oct 8]; 8(2):e000554. Available from: http://dx.doi.org/10.1136/bmjoq-2018-000554
Cunha CB, Cunha BA. Antimicrobial Therapy for Legionnaire's Disease: Antibiotic Stewardship Implications. Infect Dis Clin North Am [Internet]. 2017 [cited 2022 Oct 8]; 31(1):179-191. Available from: http://dx.doi.org/10.1016/j.idc.2016.10.013
Ripa M, Rodríguez-Núñez O, Cardozo C, Naharro-Abellán A, Almela M, Marco F, et al. Influence of empirical double-active combination antimicrobial therapy compared with active monotherapy on mortality in patients with septic shock: a propensity score-adjusted and matched analysis. J Antimicrob Chemother [Internet]. 2017 [cited 2022 Oct 8]; 12:3443–3452. Available from: http://dx.doi.org/10.1093/jac/dkx315
Jordan E, Voide C, Petignat PA, Gobin N. Céphalosporines: quelques considérations en pratique Clinique [Cephalosporins in clinical practice]. Rev Med Suisse [Internet]. 2020 [cited 2022 Oct 8]; 16(710):1906-1911. Available from: https://pubmed.ncbi.nlm.nih.gov/33058575/ 26. O’Neal F, Kramer J, Cooper M, Septimus E, Sharma S, Burgess LH. Analysis of antibiotic use in a large network of emergency departments. Am J Heal Pharm [Internet]. 2019 [cited 2022 Oct 8]; 76(21):1753–61. Available from: https://doi.org/10.1093/ajhp/zxz193
Zlamal J E, Lehyn S A, Iyer M, Elane M L, Wong N A, Wamsley J W. Shared and Unique Evolutionary Trajectories to Ciprofloxacin Resistance in Gram-Negative Bacterial Pathogens. mBio [Internet]. 2021 [cited 2022 Oct 8]; 12:e00987-21. Available from: http://dx.doi.org/10.1128/mBio.00987-21