Antimicrobial use assessment in the Intensive Care Unit of a public and reference hospital for COVID-19 in the Federal District

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DOI:

https://doi.org/10.30968/rbfhss.2023.144.0968

Abstract

Objective: To compare Intensive Care Unit antimicrobial consumption in previous periods and during the COVID-19 pandemic, to determine the prevalence of bacterial and fungal microorganisms, the prevalence of coinfection and secondary infections, and describe the profile of antimicrobial resistance throughout the pandemic. Method: retrospective observational study, from March to December 2020 in a public COVID reference hospital in the Federal District, including adult patients admitted to the ICU and using antimicrobials. Antimicrobial consumption, expressed in DDD/1000 patient-days and according to the AwaRe categorization, were compared before and during the COVID-19 pandemic. Secondary data were obtained through microbiology laboratory reports. The profile of the population was also characterized. For statistical analysis, the Mann-Whitney U test was used to compare the variables in the studied periods. Results: in the study were included 137 patients. There was a significant reduction in antimicrobial consumption in the access group Ampicillin/Sulbactam (P=0.035) during the pandemic. In the Watch group, consumption was significantly higher during the pandemic period for the antimicrobials Ceftriaxone and Piperacilian/Tazobactan (P<0.001; P= 0.015, respectively). In the Reserve group, there was a reduction in Polymyxin B during the pandemic period (P=0.029). There was also a significant reduction (P=0.009) of Echinocandins (Anidulafungin/Micafungin). Only 5.43% of patients had coinfection. Of the 731 cultures collected, 67.48% were positive for gram-negative bacteria, 19.51% for gram-positive bacteria and 13.01% for fungi. Among the microorganisms at greatest risk of antimicrobial resistance, the carbapenem-resistant Klebsiella pneumoniae species was identified in 100% of blood cultures and urine cultures and in 92% of tracheal secretion cultures; Acinetobacter spp species resistant to carbapenems occurred in 90% of blood cultures and in 98% of tracheal secretion cultures. Conclusion: the results showed a trend towards increased consumption of broad-spectrum antimicrobials in the Watch group, but with a reduction in consumption for the Reserve group. The high use of antimicrobials prior to ICU admission, associated with a reduced rate of co-infection, suggests the wide empirical use of antimicrobials in patients without proven bacterial infection. This is of concern in the context of the treatment of multidrug-resistant infections.

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Published

2024-01-08

How to Cite

1.
SANTOS AK, SANTANA LA, NOVAES MR. Antimicrobial use assessment in the Intensive Care Unit of a public and reference hospital for COVID-19 in the Federal District. Rev Bras Farm Hosp Serv Saude [Internet]. 2024Jan.8 [cited 2024Feb.22];14(4):968. Available from: https://rbfhss.org.br/sbrafh/article/view/968

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ORIGINAL ARTICLES