Intervenciones en infecciones del tracto urinario, neumonías, COVID-19 y bacteriemias por programas de uso optimizado de antimicrobianos (PROA): enfoque síndrome específico

[Interventions in urinary tract infections, pneumonias, COVID-19 and bacteremias by optimized antimicrobial use programs (PROA): syndrome-specific approach]
DOI: 10.37980/im.journal.rmdp.20211756
Publicado
2021-10-26

Descargas

Autores/as

  • José Anel González Rodriguéz Servicio de Infectología, Complejo Hospitalario Dr. Arnulfo Arias Madrid. Panamá, Caja del seguro social
  • Nathan D. Gundacker División de Enfermedades Infecciosas, Medical College of Wisconsin. Milwaukee. Estados Unidos.
  • Silvio Vega Departamento de Microbiología, Complejo Hospitalario Dr. Arnulfo Arias Madrid. Panamá, Caja de Seguro Social

Palabras clave:

programa de uso optimizado de antibióticos (PROA), neumonía, infección del tracto urinario, bacteriemia

Keywords:

optimized antibiotic use program , pneumonia, urinary tract infection, bacteremia

Resumen

Introducción: El uso de los antibióticos ha logrado curar infecciones anteriormente letales. Como profilaxis ha mejorado el pronóstico de pacientes en múltiples escenarios; sin embargo, estos fármacos tienen efectos adversos los cuales pueden ocurrir en 1 de cada 5 pacientes hospitalizados que los reciben, algunos de estos eventos son potencialmente mortales. Los programas de Antimicrobial Stewardship (ASP), conocidos en español como Programas de Uso Optimizado de Antibióticos (PROA), son intervenciones coordinadas, diseñadas para mejorar y medir el uso apropiado de antibióticos, promoviendo la selección del régimen óptimo, incluyendo dosis, duración de la terapia y su ruta de administración. Objetivo: describir el beneficio de las intervenciones síndrome específico en infecciones del tracto urinario, neumonías, bacteriemias y COVID-19, realizadas por programas de uso optimizado de antimicrobianos (PROA). Metodología: se realizó una búsqueda en PubMed y se seleccionó aquellos artículos donde se realizaron intervenciones que mostraron beneficios clínicos en infecciones del tracto urinario, neumonías, bacteriemias y COVID-19 por parte de programas de uso optimizado de antimicrobianos. Síntesis de los datos: se seleccionaron 18 estudios, de los cuales 3 mostraron intervenciones con beneficios en el tratamiento de Infecciones del tracto urinario, 9 en neumonías, 1 en COVID-19 y 5 en bacteriemias. Conclusión: Las intervenciones síndrome específicas, en Infecciones del tracto urinario (ITU), neumonías COVID-19 y bacteriemias, de los programas de uso optimizado de antibióticos (PROA) se han asociado con disminución de los costos de atención y mejores resultados clínicos.


Abstract

Objective: to describe the benefit of syndrome-specific interventions in urinary tract infections, pneumonia, bacteremia and COVID-19, performed by optimized antimicrobial use programs (PROA). Methodology: we searched PubMed and selected those articles in which interventions showing clinical benefits in urinary tract infections, pneumonia, COVID-19 and bacteremia were performed by optimized antimicrobial use programs (PROA). Data synthesis: 18 studies were selected. 3 of these studies showed beneficial interventions in the treatment of urinary tract infections, 9 in pneumonia, 1 in COVID-19 and 5 in bacteremia. Conclusion: syndrome-specific interventions in urinary tract infections, pneumonia, COVID-19 and bacteremia through optimized antimicrobial use programs have been associated with lower costs of care and better clinical outcomes.

Citas

Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an antibiotic stewardship program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62(10):e51-e77.

Tamma PD, Avdic E, Li DX, Dzintars K, Cosgrove SE. Association of adverse events with antibiotic use in hospitalized patients. JAMA Intern Med. 2017;177(9):1308-1315.

Frieden T. Antibiotic resistance threats in the United States. Centers Dis Control Prev. 2013:114.

Cecchini M, Langer J, Slawomirski L. Antimicrobial Resistance in G7 Countries and Beyond. 2015;(September). http://www.oecd.org/els/health-systems/Antimicrobial-Resistance-in-G7-Countries-and-Beyond.pdf.

Ahmad M, Khan AU. Global economic impact of antibiotic resistance: A review. J Glob Antimicrob Resist. 2019;19:313-316.

Fishman N. Policy Statement on Antimicrobial Stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol. 2012;33(4):322-327.

Foolad F, Nagel JL, Eschenauer G, Patel TS, Nguyen CT. Disease-based antimicrobial stewardship: A review of active and passive approaches to patient management. J Antimicrob Chemother. 2017;72(12):3232-3244.

Kang C, Kim J, Park DW, et al. Guia de practiga climica de ITU. 2018;50(1):67-100.

Silver SA, Baillie L, Simor AE. Positive urine cultures: A major cause of inappropriate antimicrobial use in hospitals? Can J Infect Dis Med Microbiol. 2009;20(4):107-111.

Slekovec C, Leroy J, Vernaz-Hegi N, et al. Impact of a region wide antimicrobial stewardship guideline on urinary tract infection prescription patterns. Int J Clin Pharm. 2012;34(2):325-329.

Feinstein M, Escandon-Vargas K, Reyes S, Hernández-Gomez C, Pallares C, Villegas M. Improved Outcomes When Antibiotic Are Followed By Healthcare Providers: A Colombian Example to Encourage Adherence in Hospital Settings. Infection Control & Hospital Epidemiology. 2017;vol 38, n°6.

Leis JA, Palmay L, Elligsen M, Walker SAN, Lee C, Daneman N. Lessons from audit and feedback of hospitalized patients with bacteriuria. Am J Infect Control. 2014;42(10):1136-1137.

NICE. Pneumonia in adults: diagnosis and management. Nice. 2018;(December 2014):1-18.

Mcintosh KA, Maxwell DJ, Pulver LK, et al. A quality improvement initiative to improve adherence to national guidelines for empiric management of community-acquired pneumonia in emergency departments. Int J Qual Heal Care. 2011;23(2):142-150.

Høgli JU, Garcia BH, Skjold F, Skogen V, Småbrekke L. An audit and feedback intervention study increased adherence to antibiotic prescribing guidelines at a Norwegian hospital. BMC Infect Dis. 2016;16(1):1-11.

Haas MK, Dalton K, Knepper BC, et al. Effects of a syndrome-specific antibiotic stewardship intervention for inpatient community-acquired pneumonia. Open Forum Infect Dis. 2016;3(4):1-8.

McCabe C, Kirchner C, Zhang H, Daley J, Fisman DN. Guideline-concordant therapy and reduced mortality and length of stay in adults with community-acquired pneumonia: Playing by the rules. Arch Intern Med. 2009;169(16):1525-1531.

Arnold FW, LaJoie AS, Brock GN, et al. Improving outcomes in elderly patients with community-acquired pneumonia by adhering to national guidelines: Community-acquired pneumonia organization international cohort study results. Arch Intern Med. 2009;169(16):1515-1524. doi:10.1001/archinternmed.2009.265

Athanassa Z, Makris G, Dimopoulos G, Falagas ME. Early switch to oral treatment in patients with moderate to severe community-acquired pneumonia: A meta-analysis. Drugs. 2008;68(17):2469-2481.

Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. Am J Respir Crit Care Med. 2019;200(7):E45-E67.

Dangerfield B, Chung A, Webb B, Seville MT. Predictive value of methicillin-resistant staphylococcus aureus (MRSA) nasal swab PCR assay for MRSA pneumonia. Antimicrob Agents Chemother. 2014;58(2):859-864.

Methicillin-resistant N. crossm Testing Reduces the Duration of MRSA- Targeted Therapy in Patients with. 2017;61(4):1-8.

Wilde AM, Nailor MD, Nicolau DP, Kuti JL. Inappropriate antibiotic use due to decreased compliance with a ventilator-associated pneumonia computerized clinical pathway: Implications for continuing education and prospective feedback. Pharmacotherapy. 2012;32(8):755-763.

Buchan BW, Windham S, Balada-Llasat JM, et al. Practical comparison of the BioFire FilmArray pneumonia panel to routine diagnostic methods and potential impact on antimicrobial stewardship in adult hospitalized patients with lower respiratory tract infections. J Clin Microbiol. 2020;58(7):1-21.

Keske Ş, Ergönül Ö, Tutucu F, Karaaslan D, Palaoğlu E, Can F. The rapid diagnosis of viral respiratory tract infections and its impact on antimicrobial stewardship programs. Eur J Clin Microbiol Infect Dis. 2018;37(4):779-783.

Langford BJ, So M, Raybardhan S, et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect. 2020 Dec;26(12):1622-1629.

Tiri, B.; Sensi, E, Marsiliani, V, Cantarini, et al.; et al. Antimicrobial Stewardship Program, COVID-19, and Infection Control: Spread of Carbapenem-Resistant Klebsiella Pneumoniae Colonization in ICU COVID-19 Patients. What Did Not Work? J. Clin. Med. 2020, 9, 2744

Guisado-Gil AB, Infante-Domínguez C, Peñalva G, et al. Impact of the COVID-19 Pandemic on Antimicrobial Consumption and Hospital-Acquired Candidemia and Multidrug-Resistant Bloodstream Infections. Antibiotics (Basel). 2020 Nov 17;9(11):816.

Tabah A, Koulenti D, Laupland K, et al. Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: The EUROBACT International Cohort Study. Intensive Care Med. 2012;38(12):1930-1945.

Villegas MV, Pallares CJ, Escandón-Vargas K, et al. Characterization and clinical impact of bloodstream infection caused by carbapenemase-producing enterobacteriaceae in seven Latin American countries. PLoS One. 2016;11(4):1-13.

Pogue JM, Mynatt RP, Marchaim D, et al. Automated Alerts Coupled with Antimicrobial Stewardship Intervention Lead to Decreases in Length of Stay in Patients with Gram-Negative Bacteremia. Infect Control Hosp Epidemiol. 2014;35(2):132-138.

Maeda M, Takuma T, Seki H, et al. Effect of interventions by an antimicrobial stewardship team on clinical course and economic outcome in patients with bloodstream infection. J Infect Chemother. 2016;22(2):90-95.

Perez KK, Olsen RJ, Musick WL, et al. Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic-resistant Gram-negative bacteremia. J Infect. 2014;69(3):216-225.

Wong JR, Bauer KA, Mangino JE, Goff DA. Intervenciones del farmacéutico responsable a la administración antimicrobiana para hemocultivos positivos de estafilococos coagulasa negativos usando la rápida reacción en cadena de la polimerasa. Ann Pharmacother. 2012;46(11):1484-1490.

Ly T, Gulia J, Pyrgos V, Waga M, Shoham S. Impact upon clinical outcomes of translation of PNA FISH-generated laboratory data from the clinical microbiology bench to bedside in real time. Ther Clin Risk Manag. 2008;4(3):637-640.