RESUMO
This study aimed to determine the antibiotic profile of microorganisms isolated from urine samples of patients with community urine tract infections (UTI) admitted to the University Hospital of the Federal University of Sao Carlos to support an appropriate local empirical treatment. A retrospective cross-sectional study was conducted from October 2018 to October 2020. Data from 1,528 positive urine cultures for bacterial pathogens and antibiograms were tabulated. Bacterial species prevalence and their resistance profile were analyzed and compared by sex and age. For Gram-negative fermenting bacteria, resistance rates were compared between patients with previous hospitalization and the total of infections caused by this group. For comparisons, the Chi-square test was performed, using Fisher's exact test when necessary (BioEstat program, adopting p ≤ 0.05). A multivariate analysis was applied to assess the effect of the studied variables in predicting multidrug resistance. Infections were more prevalent in women and older adults. Gram-negative bacteria represented 90.44% of total cultures. In both sexes, E. coli prevalence was significantly higher in adults compared with older adults (p < 0.0001). For several antibiotics, resistance rates were higher in the older adults compared with other ages and in patients with Gram-negative fermenting infections and previous hospitalization compared with the total of infections by this group of bacteria. The closer to the hospitalization, the higher the number of antibiotics with superior resistance rates. Resistance rates for aminoglycosides, carbapenems, ceftazidime, nitrofurantoin, piperacillin+tazobactam, and fosfomycin were less than 20%, considered adequate for empirical treatment. Only hospitalization in the previous 90 days was statistically significant in predicting infections by multidrug-resistant bacteria.
Assuntos
Antibacterianos , Infecções Urinárias , Masculino , Humanos , Feminino , Idoso , Antibacterianos/farmacologia , Brasil/epidemiologia , Estudos Transversais , Escherichia coli , Prevalência , Estudos Retrospectivos , Farmacorresistência Bacteriana , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Hospitalização , Hospitais UniversitáriosRESUMO
ABSTRACT This study aimed to determine the antibiotic profile of microorganisms isolated from urine samples of patients with community urine tract infections (UTI) admitted to the University Hospital of the Federal University of Sao Carlos to support an appropriate local empirical treatment. A retrospective cross-sectional study was conducted from October 2018 to October 2020. Data from 1,528 positive urine cultures for bacterial pathogens and antibiograms were tabulated. Bacterial species prevalence and their resistance profile were analyzed and compared by sex and age. For Gram-negative fermenting bacteria, resistance rates were compared between patients with previous hospitalization and the total of infections caused by this group. For comparisons, the Chi-square test was performed, using Fisher's exact test when necessary (BioEstat program, adopting p ≤ 0.05). A multivariate analysis was applied to assess the effect of the studied variables in predicting multidrug resistance. Infections were more prevalent in women and older adults. Gram-negative bacteria represented 90.44% of total cultures. In both sexes, E. coli prevalence was significantly higher in adults compared with older adults (p < 0.0001). For several antibiotics, resistance rates were higher in the older adults compared with other ages and in patients with Gram-negative fermenting infections and previous hospitalization compared with the total of infections by this group of bacteria. The closer to the hospitalization, the higher the number of antibiotics with superior resistance rates. Resistance rates for aminoglycosides, carbapenems, ceftazidime, nitrofurantoin, piperacillin+tazobactam, and fosfomycin were less than 20%, considered adequate for empirical treatment. Only hospitalization in the previous 90 days was statistically significant in predicting infections by multidrug-resistant bacteria.
RESUMO
Introdução: O uso do biomarcador procalcitonina (PCT) de forma racionalizada pode contribuir para reduzir o uso excessivo de antimicrobianos, poupar recursos e qualificar o cuidado com o paciente. Objetivo: Avaliar a eficácia da PCT na redução do tempo de tratamento com antimicrobianos e o impacto financeiro e factibilidade da incorporação desta tecnologia a partir de cenários simulados em um hospital de pequeno porte e média complexidade. Material e Métodos: Revisão da literatura, a partir da base de dados Pubmed seguida de análise de custo em quatro cenários simulados, comparando o PCR com a PCT. Foram incluídos ensaios clínicos randomizados e revisões sistemáticas cuja intervenção consistia no uso de PCT para guiar o tempo de tratamento com antimicrobianos. A seleção e extração dos dados foi realizada por quatro revisores independentes. A análise de custo foi realizada por meio de cenários simulados com os antimicrobianos de maior impacto na instituição totalizando doze terapias analisadas, a partir de dados de custos efetivamente desembolsados. Resultados: Foram selecionados 8 artigos para a análise final. A PCT possibilitou redução significativa de tempo de tratamento, redução de mortalidade, tempo de internação, eventos adversos e custos. A simulação de custo demonstrou que o cenário com PCT foi mais econômico para 67% das terapias analisadas, chegando à uma economia de até R$567,86 por tratamento, no caso da terapia combinada com meropenem, vancomicina e polimixina. Conclusão: A terapia guiada pela PCT reduz tempo de tratamento, internação e mortalidade apresentando impacto considerável na redução dos custos diretos, sendo factível a sua incorporação no cenário analisado
Introduction: The use of the procalcitonin (PCT) biomarker in a rationalized manner can contribute to reducing the excessive usage of antimicrobial, saving resources and improving patient care. Objective: To evaluate the effectiveness of PCT in reducing antimicrobial treatment time and the financial impact and feasibility of incorporating this technology based on simulated scenarios in a small and medium-complexity hospital. Material and Methods: Literature review, based on the Pubmed database followed by cost analysis in four simulated scenarios, comparing PCR with PCT test. Randomized clinical trials and systematic reviews whose intervention consisted of the use of PCT to guide the duration of antimicrobial treatment were included. Data selection and extraction was carried out by four independent reviewers. The cost analysis was carried out through simulated scenarios with the twelve therapies with the greatest impact on the institution, based on data of costs actually disbursed. Results: The final analysis included 8 articles. PCT resulted in significant reduction of duration of antibiotic treatment, reduction in mortality, length of stay, adverse events and costs. The cost simulation demonstrated that the PCT scenario was more economical for 67% of therapies analyzed, reaching savings up to R$567.86 per treatment, in the case of combined therapy with meropenem, vancomycin and polymyxin.Conclusion: PCT-guided therapy reduces treatment duration, hospitalization and mortality, presenting a considerable impact on reducing direct costs, making it feasible to incorporate it into the analyzed scenario.