Padrão de consumo de antibacterianos em uma UTI geral: correlação com a resistência bacteriana

AUTOR(ES)
DATA DE PUBLICAÇÃO

2006

RESUMO

Introduction: The bacterial resistance is a global public health and emergent problem. The selective pressure of antibiotic use is a predisposing factor, specially if the use is inappropriate. The antibacterial consumption monitoring is a strategical element of bacterial resistance control program. Objectives: The principal aim was to quantify the antibacterial consumption pattern in an Intensive Care Unit (ICU). Furthermore, to estimate the association between this consumption and resistant bacteria rates and to compare the data obtained from the aggregated and individual form. Methods: Descriptive ecological study made in a medical-surgical ICU of a public regional hospital in Brasília, from 1999 to 2004. The Anatomical Therapeutical and Chemical (ATC) classification and the Defined Daily Doses (DDD) were used for the antibacterial consumption quantification. The data was obtained from the random samples of 438 pacients stratified by years. The data of pharmaceutical information system was collected parallel. Fifteen selected bacteria-antibacterial pairs were evaluated for resistance. The incidence density of antibacterial use and bacterial resistance were correlated. Results: The antibacterial use obtained from amostral study was different from the pharmaceutical information system. This fact demonstrated the quality deficit of pharmacys data. In the sample study, 73,1% pacients used antibacterial agents and the global use density was 1487, DDD for 1000 pacients-day (or DDD1000). Third and fourth generation cephalosporins (380 DDD1000), carbapenems (282,4 DDD1000), and glycopeptides (161,2 DDD1000) were the most used antibacterial agents. Among the bacteria-antibacterial pairs, staphylococcal resistance and multiresistant P. aeruginosa were the most important. Association was found between carbapenems use and carbapenems resistance P. aeruginosa (r= 0,83 e p= 0,02) and this was epidemiologically important. Conclusion: This study showed a higher consume of third and fourth generation cefalosporins, carbapenens and glicopeptídeos. Furthermore, demonstrated an allarming bacterial resistance pattern. These patterns indicate the necessity to improve prudence in the use of antimicrobial agents. The study showed the importance of monitoring antimicrobial use and bacterial resistance and the utility of ATC-DDD system for standartization and comparisons.

ASSUNTO(S)

agentes antibacterianos resistência bacteriana medicina

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