Avaliação do uso de antimicrobianos e resistência microbiana: análise de séries temporais dos resultados de um programa de gerenciamento de antimicrobianos em um hospital público de ensino.

Abstract

Antimicrobial resistance (AMR) is considered one of the major global challenges in public health nowadays due to its potential impact on human and animal health and the significant increase in healthcare costs. Antimicrobial Stewardship Programs (ASP) represent a useful strategy consisting of actions to promote responsible antimicrobial use (ATM), which the COVID-19 pandemic may have impacted. This study analyzed the ASP based on the quality assessment model involving the dimensions of "structure", "process", and "outcome" proposed by Donabedian and evaluated the temporal evolution of ATM consumption and the epidemiological distribution of multidrug-resistant microorganisms (MDRO) between 2015 and 2021. The study site was a general, public teaching hospital that belongs to Brazil's Unified Health System. The activities of the ASP were managed in this institution by the hospital infection control committee (HICC), hospital pharmacy (HP) and the diagnostic support laboratory (DSL), and these actors were characterized from the Donabedian perspective. The distribution among the dimensions was guided by the checklist of the essential elements of ASP that make up the national regulatory requirements. The checklist was applied in July 2022. ATM consumption was measured in defined daily doses (DDD) and calculated per 1000 patient-days. Data collection was performed by extraction of ATM consumption reports. The data were tabulated in a Microsoft Office Excel (2003) spreadsheet, plotted monthly from January 2015 to December 2021. The incidence of MDRO was collected from the HICC´s specialized reports. To account for changes in ATM consumption and MDRO incidence over time, we calculated the compound annual growth rate, which presents the average yearly change as a proportion (%) of consumption in the initial year. All statistical analyses were performed using R statistical software (version 4.0; R Foundation for Statistical Computing, Vienna, Austria). The structure, main processes and indicators related to HICC, HP and LDS were mapped, characterizing the ASP in the institution. Of the 60 items that compose the checklist, the hospital met 73.3% of the requirements items (n=44). As for the ATM consumption results, daptomycin and linezolid had the highest variations in consumption in the period (39.4 and 27.7%, respectively), followed by the polymyxins antibacterials (9.8%). The MDROs in the ESKAPE group with the greatest variation in the period were Staphylococcus (aureus, sp) (29.2%), Enterococcus (faecium, faecalis, sp) (27.8%) and Acinetobacter (baumannii, sp) (18.4%). Other MDRO, outside the ESKAPE group, with significant variation were Providencia sp (51.2%) and Clostridioides dificille (37.7%). In conclusion, although the hospital does not yet have a classical ASP model, there were investments to improve the quality of ATM use and comply with international guidelines. The pandemic may have further deteriorated the scenario of an accelerating increase in ATM. This warrants further investigation of surveillance data on the epidemiological trends of AMR.