ANÁLISE DO USO DE ANTIMICROBIANOS E O IMPACTO NA RESISTÊNCIA BACTERIANA EM PACIENTES DO CENTRO DE TERAPIA INTENSIVA DE UM HOSPITAL UNIVERSITÁRIO EM MINAS GERAIS
DOI:
https://doi.org/10.36557/2674-8169.2024v6n4p590-604Keywords:
Carbapenemases; Klebsiella pneumoniae produtoras de KPC; COVID-19; KPCAbstract
The present study aims to describe the profile of antimicrobial use in the Intensive Care Unit of the University Hospital of the Federal University of Juiz de Fora; analyze the results of the Antimicrobial Susceptibility Test of bacterial strains isolated from clinical specimens and evaluate the prevalence of multidrug-resistant bacterial species from the specimens. Thus, it is characterized as a retrospective descriptive cross-sectional study carried out from the analysis of patients' medical records of which, in clinical samples of tracheal aspirate, positive culture was identified for multidrug-resistant bacteria producing carbapenemases hospitalized in the period from 2020 to 2022, at the Santa Catarina University Hospital in Juiz de Fora (HU-UFJF). It was observed that factors such as: prolonged ICU stay, use of invasive devices, comorbidities, age, previous use of broad-spectrum antimicrobials, COVID co-infection, and gram-negative co-infections can contribute to a poor prognosis of patients. Despite the development of new antimicrobials, such as ceftazidime/avibactam for the treatment of carbapenemase-producing bacteria, it is necessary to implement strict measures to control the use of these drugs.
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ALMEIDA, A. S.; BAPTISTA, P. F.; LIMA, T. M. Atuação do farmacêutico no gerenciamento de antimicrobianos no Brasil: uma revisão da literatura. Brazilian Journal of Health and Pharmacy, v. 4, n.2, p. 01–20, 2022.
BASSETTI, M; PEGHIN, M. How to manage KPC infections. Ther Adv Infect Dis, v.7, 2020
BRANDÃO, C. et al. Severe COVID-19: understanding the role of immunity, endothelium, and coagulation in clinical practice. J Vasc Bras. 2020.
BRASIL, Conselho Federal de Farmácia. Resolução CFF n° 585, de 29 de agosto de 2013. Regulamenta as atribuições clínicas do farmacêutico e dá outras providências. Diário Oficial da União. Brasília, Distrito Federal, 25 set. 2013 – Seção 1, 186p.
COJUTTI, P, et al. Population Pharmacokinetics of High-Dose Continuous-Infusion Meropenem and Considerations for Use in the Treatment of Infections Due to KPC-Producing Klebsiella pneumoniae. Antimicrob Agents Chemother, v.61, n.10.2017.
DUARTE, G. E. et al. Resistance profile of microorganisms isolated in the Microbiology Service of the Hospital Nacional in the year 2017. Del Nacional, v. 10, n.2, p. 21-38, 2018.
DUMITRU, M. et al. I. Carbapenem-Resistant Klebsiella pneumoniae Associated with COVID-19. Antibiotics (Basel), v.10, n.5, p.561, 2021. doi: 10.3390/antibiotics10050561. PMID: 34065029; PMCID: PMC8151469.
EBSERH. Empresa Brasileira de Serviços Hospitalares. Prescrição de Ceftazidima-Avibactam 2000mg + 500mg, 2023. Disponível em: <https://www.gov.br/ebserh/pt-br/hospitais-universitarios/regiao-sudeste/hu-ufjf/acesso-a-informacao/nucleo-de-qualidade-hospitalar-gestao-de-documentos/superintendencia/setor-de-gestao-da-qualidade/prt-stgq-001-prescricao-de-ceftazidima-avibactam-2000mg-500mg.pdf/view>. Acesso em: 26 de fev. de 2024.
ESPOSITO, S.; SIMONE, G. Update on the main MDR pathogens: prevalence and treatment options. Infez Med, v.25, n.4, p.301-310, 2017.
GIACOBBE, D. R. et al. Treatment and diagnosis of severe KPC-producing Klebsiella pneumoniae infections: a perspective on what has changed over last decades. Ann Med, v.55, n.1, p.101-113. 2023.
SANZ, H. Ceftazidime-avibactam. Rev Esp Quimioter. Suppl 1, p. 40-42, 2022. doi: 10.37201/req/s01.09.2022. Epub 2022 Apr 22. PMID: 35488824; PMCID: PMC9106208.
HU, Y. et al. Prevalence, risk factors and molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae in patients from Zhejiang, China, 2008-2018. Emerg Microbes Infect. v.9, n.1, p. 1771-1779, 2020. doi: 10.1080/22221751.2020.1799721. PMID: 32689907; PMCID: PMC7475806.
KAPOOR, G.; SAIGAL, S.; ELONGAVAN, A. Action and resistance mechanisms of antibiotics: A guide for clinicians. J Anaesthesiol Clin Pharmacol, v.33, n.3, p.300-305, 2017.
MATHERS, A. et al. Risk factors for Klebsiella pneumoniae carbapenemase (KPC) gene acquisition and clinical outcomes across multiple bacterial species. J Hosp Infect, v. 104, n.4, p. 456-468, 2020. doi: 10.1016/j.jhin.2020.01.005. Epub 2020 Jan 10. PMID: 31931046; PMCID: PMC7193892.
MOUBARECK, C.; HAMMOUDI H. The Collateral Effects of COVID-19 Pandemic on the Status of Carbapenemase-Producing Pathogens. Front Cell Infect Microbiol, v.17, 2022. doi: 10.3389/fcimb.2022.823626. PMID: 35372126; PMCID: PMC8968076.
NICOLAU, D. P. Pharmacokinetic and pharmacodynamic properties of meropenem. Clin Infect Dis. v.47 Suppl 1. p.32-40. 2008
OMS. Organização Mundial de Saúde. A crescente ameaça da resistência antimicrobiana: opções de ação: sumário executivo. Brasília: OMS; 2012. 16 p.
ONU News. Mais de 50% das infecções bacterianas que podem causar mortes estão se tornando resistentes a tratamento, revela um novo relatório da Organização Mundial da Saúde, OMS. 2022. Disponível em: https://news.un.org/pt/story/2022/12/1806582. Acesso em: 15 jan. 2024.
PINTADO, V. et al. Carbapenemase-producing Enterobacterales infections in COVID-19 patients. Infect Dis (Lond), v. 54, n.1, p. 36-45, 2022. doi: 10.1080/23744235.2021.1963471. Epub 2021 Aug 12. PMID: 34382910; PMCID: PMC8425444.
ROSA, F. G. et al. Critical issues for Klebsiella pneumoniae KPC-carbapenemase producing K. pneumoniae infections: a critical agenda. Future Microbiology, v.10, n.2, p. 283–294, 2015.
SCHIRMER, A. A.; BECCARIA, C. S.; COSER, H. S. Enterobactérias produtoras de carbapenemase (KPC): alternativas para farmacoterapia atual. Brazilian Journal of Surgery and Clinical Research, v.33, n.3, p.62-69. 2020.
SHEU, C. et al. Infections Caused by Carbapenem-Resistant Enterobacteriaceae: An Update on Therapeutic Options. Front Microbiol. v. 10, n.80. 2019.
SILVA, J. O.; PAIXÃO, J. A. Resistência bacteriana e a atuação do farmacêutico na promoção do uso racional de antibacterianos em âmbito hospitalar. Revista Artigos. 2021. Disponível em: <https://acervomais.com.br/index.php/artigos/article/view/7563> acesso em: 22 set. 2023.
SORIANO A. et al. Ceftazidime-Avibactam for the Treatment of Serious Gram-Negative Infections with Limited Treatment Options: A Systematic Literature Review. Infect Dis Ther, v.10, n.4, p.1989-2034, 2021.
SOUZA, F. D.; BARONI, M. F.; ROESE, F. M. Profile of antimicrobial use in the intensive care unit of a public hospital. Rev Bras Farm Hosp Serv Saúde. São Paulo, v.8, n.4, p. 37-44. 2017.
TUMBARELLO, M. et al. "Predictive models for identification of hospitalized patients harboring KPC-producing Klebsiella pneumoniae. Antimicrob Agents Chemother.. v.58, p.3514–3520. 2014.
TUMBARELLO, M. et al. Ceftazidime-Avibactam Use for Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae Infections: A Retrospective Observational Multicenter Study. Clin Infect Dis. 2021 Nov 2;73(9):1664-1676. doi: 10.1093/cid/ciab176. PMID: 33618353.
WANG, G. et al. The Characteristic of Virulence, Biofilm and Antibiotic Resistance of Klebsiella pneumoniae. Int J Environ Res Public Health, v.17, 2020.
YU, WL. MDClinical features, diagnosis, and treatment of Klebsiella pneumoniae infection. Uptodate 2023.
WHO. World Health Organization Antimicrobial Resistance. 2021. disponível em: <https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance> acesso em: 22 jun. 2023.
WHO. World Health Organization. Global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics. Genebra. 2017. Disponível em: <http://remed.org/wp-content/uploads/2017/03/lobal-priority-list-of-antibiotic-resistant-bacteria-2017.pdf> acesso em: 26 jun. 2023.
WHO. World Health Organization. Antimicrobial stewardship programmes in health-care facilities in low- and middle-income countries. A practical toolkit. Geneva: World Health Organization. 2019. Disponível em: <https://www.who.int/publications/i/item/9789241515481> acesso em: 30 dez. 2023.
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Copyright (c) 2024 Anna Karolina Raquel Duarte Barroso, Marcelo Silva Silvério, Patrícia Guedes Garcia, Alessandra Esther de Mendonça, Olavo dos Santos Pereira Júnior, Windson Hebert Araújo Soares, Danielle Oliveira da Fonseca
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