Rodríguez-Badillo R, Castorena AG, González DF, Suárez VM, Arroyo ES, Moncada BD, Puga CL, Guillen AN

Language: Spanish
References: 27
Page: 87-96
PDF size: 418.82 Kb.

ABSTRACT

Nosocomial infections and the antimicrobial resistance are the most important problems in hospitals. The best antimicrobial prescription reduce mortality and costs. We need to have information systems that lets us know the real situation in each medical area to improve the antimicrobial prescription and prevent nosocomial infections.
Material y methods: We monitored during 5 years the antimicrobial prescription and the antimicrobial resistance in an Intensive Care Unit using a computer program developed by us related to antimicrobial prescription and nosocomial infections.
Results: The computer program developed let us have information related to an antimicrobial resistance y develop of resistance. P aeruginosa, K pneumoniae and A baumannii were the predominant pathogens and were considered as multi drug resistance (MDR). Carbapenemics were the main antibiotics used (25%), ventilator associated pneumonia were the predominant infection found (30%). It was documented two epidemics events in a early way. It were elaborated and used guidelines of antimicrobial prescription for ICU and it was required work with the Epidemiologic department. With the use of both programs we improved de prescription of antibiotics (50% to 70%).
Conclusions: It´s important to have programs related to antimicrobial prescription and evidence of antimicrobial resistance to do best antimicrobial prescription, to stablish endemical patrons and realize medical process to reduce antimicrobial resistance and nosocomial infections and can give to medical staff tools that let them can do a best antimicrobial prescription.

REFERENCES

1. Sande MA, Kapusnik-Uner JE, Mandell GL. Agentes Antimicrobianos. Consideraciones Generales. En: Godman y Gilman. Las Bases Farmacológicas de la Terpéutica. Panamericana 8ª Ed. 1991:991-1017.

2. Alder JL, Burke JP, Finland M. Infection and antibiotic usage at Boston City Hospital, 1970. Archs Intern Med 1971; 127: 460-465.

3. Bauer AW, Kirby WM, Sherris JC, Turk M. Antibiotic susceptibility testing by a standardized single disc method. Am J Clin Pathol 1966;45:493-496.

4. Niederman MS. Impact of antibiotic resistance on clinical outcomes and the cost of care. Crit Care Med 2001;29(4):N114-N120.

5. Kollef M, Niederman M. Antimicrobial resistance in the ICU: The time for action is now. Crit Care Med 2001; 29(4): N63.

6. Fridkin SK. Increasing prevalence of antimicrobial resistance in intensive care units. Crit Care Med 2001; 29(4):N64-N68.

7. Tánger O, Dinc G, Özbakkaloglu B, Atman UC, Algún U. Evaluation of rational antibiotic use International. J Antimicrobial Agents 2000;15:131-135.

8. Thuong M, Shortgen F, Zazempa V, Girou E, Soussy CJ, Brun-Buisson C. Apropiate use of restricted antimicrobial agents in hospitals: the important of empirical therapy and assisted re-evaluation. J Antimicrobiol Chemotheraphy 2000;46:501-508.

9. Cizman M. The use and resistance to antibiotis in the community. Inter J Antimicrobial Agents 2003;21:297-307.

10. INEGI, Estadísticas de Mortalidad en México: muertes registradas en el 2001. Sal Pub Méx 2002;44(6):565-81.

11. INEGI, Estadísticas de egresos hospitalarios del sector público del Sistema Nacional de Salud, 2002. Sal Púb Méx 2003;45(6):512-33.

12. Shapiro M. Use of antimicrobial drugs in general hospitals. N Engl J Med 1979;381(7):351-5.

13. Maldonado C. Uso y prescripción de medicamentos antimicrobianos en el Hospital de Apoyo de la Merced. Rev Perú Med Exp Salud Pública 2002;19(4):181-85.

14. Rivero M. Uso de antimicrobianos en el Servicio de Medicina Interna de un Hospital General. Rev Epidem Esp 1999;35(6):159-167.

15. Geddes AM. Antibiotic Therapy. A resume. Lancet 1988;(8580):286-9.

16. Liss RH, Batchelor FR. Economic evolutions of antibiotics use and resistance, a prospective. Rev Infect Dis 1987;9:297-312.

17. OMS. Cómo desarrollar y aplicar una política farmacéutica nacional. Perspectivas políticas de la OMS sobre medicamentos, 2003:1-6.

18. Lesch CA, Itokazu GS, Danziger LH, Weistein RA. Multi-hospital analysis of antimicrobial usage and resistance trends. Diagnostic Microbiology and Infectous Disease 2001;41:149-154.

19. Brown EM. Guidelines for antibiotic usage in hospitals. J Antimicrobial Chemotherapy 2002;49:587-592.

20. Pestontnik SL, Classen DC, Evans RS, et al. Implementing antibiotic practice guidelines through computer-assisted decision support: Clinical and financial outcomes. Ann Intern Med 1996;124:884-890.

21. Evans RS, Pestotnik SL, Classen DC, et al. A computer-assisted management program for antibiotics and other antiinfective agents. N Engl J Med 1998;338:232-238.

22. Pestotnik SL, Evans RS, Burke JP, et al: Therapheutic antibiotic monitoring: surveillance using a computerized expert system. Am J Med 1990;88:43-48.

23. Ringold DJ, Santell JP, Scheneider PJ, et al. ASHP national survey of pharmacy practice in acute care settings: Prescribing and transcribing-1988. Am J Health Syst Pharm 1999;56:142-157.

24. DeLisle S, Perl TM. Antimicrobial management measures to limit resistance: A process-based conceptual framework. Crit Care Med 2001;29(4):N121-N127.

25. Bouza E, Garcia-Gorrote F, Cercenado E, Marin M, Díaz MS. Pseudomonas aeruginosa: a survey of resistance in 136 hospitals in Spain. The Spanish Psedomonas aeruginosa study group. Antimicrob Agents Chemother 1999;43(4):981-2.

26. Bonfiglio G, Carciotto V, Russo G, Stefani S, Schito GC, Debbia E, et al. Antibiotic resistance in Pseudomonas aeruginosa: an Italian survey. J Antimicrob Chemother 1984;41(2):307-10.

27. Spencer RC. An 8-year microbe base survey of the epidemiology, frequency and antibiotic susceptibility of Pseudomonas aeruginosa hospital isolates in the United Kingdom. J Antimicrob Chemother 1996;37(2):295-301.