Análise do consumo de antimicrobianos em um complexo hospitalar de Belo Horizonte.

Abstract

Antimicrobial resistance is considered one of the major threats to global health. Several researches efforts, actions and public policies have been developed to optimize the use of antimicrobials. Antimicrobial management in hospitals emerges as an important strategy to promoting appropriate use and reducing multidrug resistance. The study aimed to analyze the consumption of antimicrobials in a hospital complex located in Minas Gerais, from 2018 to 2021. The descriptive study was divided into two main aspects: first an evaluation of antimicrobials available in the hospital complex, using data from drug registration in national and international medication agencies and consumption reports from the investigated institution, related to the drugs existing on the market, and a quantitative analysis of antibacterial consumption in the institution. Antibacterials were classified according to the AWaRE system. Also, Forgotten antibiotics and new antimicrobials were identified.The consumption of antimicrobials was expressed in Defined Daily Doses (DDD)/ 1000 hospital bed/ days. The Drug utilization 90% index (DU90) was calculated by chemical group from Anatomical Therapeutic Chemical (ATC) classification and for each antibacterial for each year investigated. We calculated a compound annual growth rate (CAGR) in order to verify annual changes in the most consumed antimicrobials over the study period. The database was developed in Excell Software and statistical analysis was performed using the Statistical Package for Social Sciences® (SPSS®) software, version 25.0. Regarding the ATC classification, the drugs available in the hospital complex were in the following groups: J01 - Antibacterials for systemic use (76.3%), followed by J02 - Antimycotics for systemic use (18.6%) and J05 - Antivirals for systemic use (5.1%). According to WHO AWaRE classification, out of the 45 antibacterials available, 21 were in the Access group, 17 in the Watch group and 7 in the Reserve group. Among the 37 Forgotten antibiotics, 23 had an ANVISA registration, 8 were present in RENAME list and 14 were available in the hospital complex for consumption. Among the 21 new antibiotics, 7 were had ANVISA registration and only one was available for consumption at the institution and belonged to the Reserve group of the AWaRE classification. The most consumed antibacterials in the hospital complex were: J01DH – carbapenems; J01CR – penicillins + beta-lactamase inhibitor; J01CF – beta-lactamase resistant penicillins; J01XA – glycopeptides and J01MA – fluoroquinolones. Antibiotics with CARG that showed an increase between 2018 and 2021 exceeding 20% were: amikacin (50.12%); benzylpenicillin (24.33%); oral clarithromycin (51.06%); daptomycin (34.38%), polymyxin B (20.85%) and tigecycline (41.49%). Related to the AWaRE classification, antibacterials in the Alert group exhibited higher consumption levels throughout the study period, while there was a corresponding decline in the Access group. On the other hand, antibacterials in the Reserve group showed an increase in consumption over the years. The inclusion of new antimicrobials into the hospital complex's pharmaceutical formulary was limited and the pattern of antimicrobial use in the hospital complex from 2018 to 2021 showed an increase in consumption in medical and intensive care units, with a predominance of carbapenems, penicillins + beta-lactamase inhibitors, beta-lactamase resistant penicillins, glycopeptides and fluoroquinolones, reflecting the healthcare profile and the influence of the COVID-19 pandemic.