RESUMEN
The objective of the study was to evaluate the capacity of GERH®-derived local resistance maps (LRMs) to predict antibiotic susceptibility profiles and recommend the appropriate empirical treatment for ICU patients with nosocomial infection. Data gathered between 2007 and 2016 were retrospectively studied to compare susceptibility information from antibiograms of microorganisms isolated in blood cultures, lower respiratory tract samples, and urine samples from all ICU patients meeting clinical criteria for infection with the susceptibility mapped by LRMs for these bacterial species. Susceptibility described by LRMs was concordant with in vitro study results in 73.9% of cases. The LRM-predicted outcome agreed with the antibiogram result in >90% of cases infected with the bacteria for which GERH® offers data on susceptibility to daptomycin, vancomycin, teicoplanin, linezolid, and rifampicin. Full adherence to LRM recommendations would have improved the percentage adequacy of empirical prescriptions by 2.2% for lower respiratory tract infections (p = 0.018), 3.1% for bacteremia (p = 0.07), and 5.3% for urinary tract infections (p = 0.142). LRMs may moderately improve the adequacy of empirical antibiotic therapy, especially for lower respiratory tract infections. LRMs recommend appropriate prescriptions in approximately 50% of cases but are less useful in patients with bacteremia or urinary tract infection.
RESUMEN
Introducción. La falta de adherencia a los tratamientos antibióticos es una cuestión de especial interés, que tiene importantes implicaciones clínicas, pues se asocia a fallo terapéutico y al aumento de las resistencias bacterianas, ocasionando un alto coste sanitario. El objetivo de nuestro trabajo fue valorar, en pacientes ambulatorios, el grado de adherencia a los tratamientos antibióticos prescritos, a través de la detección de éstos en sangre, orina o esputo. Material y métodos. Se determinaron las concentraciones de los antibióticos prescritos en 39 pacientes (34 con sospecha clínica de infección del tracto urinario y 5 de infección de vías respiratorias bajas) atendidos en consultas de Atención Primaria del Distrito Sanitario de Almería (España), mediante una técnica de cromatografía líquida acoplada a espectrometría de masas en tándem. Resultados. El 48,7% de los pacientes no cumplió de manera correcta con el tratamiento indicado, debido a la omisión completa o parcial en la toma de los antibióticos prescritos. Esta falta de adherencia fue independiente de la edad y sexo de los pacientes, del número de dosis diarias del antibiótico y de que estuvieran, o no, recibiendo otra medicación. Conclusiones. Consideramos que técnicas analíticas precisas, como la cromatografía líquida, pueden ser útiles para detectar los tratamientos inadecuados o incompletos, así como el grado de adherencia de los pacientes ambulatorios, y, de esta forma, poder establecer medidas adecuadas que incidan en el control del cumplimiento terapéutico (AU)
Introduction. The lack of adherence to antibiotic treatments is a matter of special interest, which has important clinical implications, as it is associated with therapeutic failure and increased bacterial resistance causing a high sanitary cost. The objective of our study was to assess the degree of adherence to prescribed antibiotic treatment in outpatients through the detection of these in blood, urine or sputum. Material and methods. Concentrations of antibiotics prescribed in 39 patients (34 with clinical suspicion of urinary tract infection and 5 with clinical suspicion of low respiratory tract infection) treated in Primary Care consultations of the Sanitary District of Almería (Spain) were determined by ultrahigh performance liquid chromatography coupled to tandem mass spectrometry. Results. A 48.7% of the patients did not comply correctly with the indicated treatment due to the complete or partial omission in taking the prescribed antibiotics. This lack of adherence was independent of the age and sex of the patients, the number of daily doses of the antibiotic, and whether or not they were receiving another medication. Conclusions. Precise analytical techniques such as liquid chromatography can be useful to detect inadequate or incomplete treatments as well as the degree of adherence of outpatients. Thus, adequate measures could be established that affect the control of therapeutic compliance (AU)