RESUMO
Background: Polypharmacy and the use of high-alert medications in patients with nasally placed feeding tube (NPFT) increase the risks of drug related problems. Objective: Characterize drugs prescribed to patients with NPFT and compare the rates of polypharmacy and high-alert medication use at admission and hospital discharge. Design and setting: Multicenter cross-sectional study with 327 participants. Methods: Data of patients with NPFT were obtained from the medical records and recorded in an electronic data collection tool. Mean number of drugs, polypharmacy and number of high-alert medications prescribed on admission and at discharge were compared using Wilcoxon or McNemar's tests. Generalized Estimating Equations analyzed the relationship between polypharmacy and high-alert medications according to age and time point. Primary reason for hospital admission, level of consciousness, severity of comorbid diseases and patient care complexity were also assessed. Results: Most patients were male, older people, hospitalized for circulatory system diseases and had at least one comorbidity. On admission, a significant number of patients were alert (59.9%), at high risk for death (43.1%) and high dependent on nursing care (35.4%). Additionally, 92% patients were on polypharmacy on admission, versus 84.7% at hospital discharge (p = 0,0011). The occurrence of polypharmacy was independent of age (p = 0.2377). >17% of all drugs prescribed were high-alert medications, with no statistically significant difference between admission and discharge (p = 0,3957). There was no statistical evidence that the use of high-alert medications increases with age (n = 0,5426). Conclusions: These results support the planning of multidisciplinary qualified actions for patients using NPFT.
RESUMO
OBJECTIVE: This research aimed to evaluate the impact of custom-developed software on nursing students' alcohol consumption and perception of social support. METHOD: A quasi-experimental study was conducted with 88 students in the early years of nursing courses at a Brazilian public university. The members of the intervention group (n = 40) participated in a lecture delivered by a nurse and used online software developed based on cognitive behavioral techniques and social skills training. The members of the control group (n = 48) participated only in the lecture. Data on alcohol consumption profiles and social support characteristics were collected. Descriptive statistics, an analysis of variance test, and the Dunnett's test were utilized for data analysis. RESULTS: Alcohol consumption decreased in both groups without significant differences between them. However, in terms of frequency of use, binge drinking, and the number of drinks consumed, a significant decrease occurred among participants in the intervention group. Regarding social support, both groups showed an increase in satisfaction with support and a decrease in the number of supporters. This reduction was less pronounced in the intervention group than in the control group. CONCLUSION: This investigation presents relevant results that suggest the potential of using online technologies as supplemental materials for promoting students' mental health.
Assuntos
Consumo de Bebidas Alcoólicas , Apoio Social , Estudantes de Enfermagem , Humanos , Feminino , Estudantes de Enfermagem/psicologia , Masculino , Consumo de Bebidas Alcoólicas/epidemiologia , Adulto Jovem , Adulto , BrasilRESUMO
OBJECTIVES: Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. METHODS: A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by 2 independent researchers. Experimental and observational studies were eligible for inclusion. RESULTS: Out of the 5791 studies retrieved, after excluding duplicates (nâ¯=â¯1050), conducting title/abstract screening (nâ¯=â¯4741), and full reading (nâ¯=â¯41), only 1 study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75â¯years or older (nâ¯=â¯130) with limited life expectancy and polypharmacy were allocated to 2 groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. CONCLUSIONS: Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only 1 of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear.
Assuntos
Desprescrições , Cuidados Paliativos , Idoso , Humanos , Prescrição Inadequada/prevenção & controle , Polimedicação , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de RiscoRESUMO
INTRODUCTION: Allogeneic Hematopoietic Stem Cells Transplantation (allo-HSCT) is capable of curing patients with neoplastic or non-neoplastic hematologic disorders or of prolonging their survival. This study assessed if the insertion of the clinical pharmacist in the allo-HSCT team modified the outcomes: transplantation-related mortality, grafting failure, incidence of Graft versus Host Disease, hospitalization time, time for grafting, number of readmissions, number of drug-related problems (DRPs), adherence and knowledge about pharmacotherapy. METHODS: Interventional study with historical control carried out in an allo-HSCT unit, in which the intervention group (IG) included 33 individuals who received pharmacotherapy follow-up. Control Group (CG) consisted of 28 individuals. RESULTS: A total of 250 DRPs were identified, 59 team's doubts were clarified, and 309 interventions were conducted in the IG. The DRPs mainly arose from safety (51.60%) and effectiveness (38.40%) problems. A mean of 9.36 (SD = 6.97) interventions per patient was obtained, mainly including dose reductions (19.09%), adjustments in administration time (18.12%), educational activities (15.21%) and drug removal (10.68%). Clinical significance of the interventions was considered high (75.7% extremely significant, very significant or significant), as well as their acceptability (89.7% accepted). Each patient attended a mean of 4.68 pharmaceutical consultations (SD = 1.91) after hospital discharge, presenting increase in knowledge (p = 0.0001) and in adherence (p = 0.0115). There was no evidence of differences between the groups in the other outcomes analyzed. CONCLUSIONS: The pharmacotherapy follow-up allowed detecting several DRPs and performing interventions of high clinical relevance and acceptability, in addition to improving adherence and individualizing the pharmacotherapy.
Assuntos
Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Humanos , Farmacêuticos , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Hospitalização , Doença Enxerto-Hospedeiro/prevenção & controle , Doença Enxerto-Hospedeiro/etiologia , Células-Tronco Hematopoéticas , Estudos RetrospectivosRESUMO
BACKGROUND: Allogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT) is currently one of the most effective therapies in onco-hematology. For the treatment of the disease and prevention of such complications, a complex pharmacotherapeutic regimen is employed. Non-compliance is prevalent among adolescents and young adults with chronic hematological diseases, being reported by up to 50% of the patients. OBJECTIVE: To evaluate the results of pharmacotherapeutic follow-up on medication compliance and on the knowledge about pharmacotherapy of patients who underwent allo-HSCT. METHODS: A single-arm, open-label and non-randomized intervention study developed in an allo-HSCT outpatient clinic. The participants attended pharmaceutical consultations and had their knowledge about pharmacotherapy and medication compliance measured by MedTake and Brief Medication Questionnaire (BMQ), respectively. RESULTS: A total of 27 patients attended pharmaceutical consultations (4.81 consultations/patient; SD = 1.80). There was an improvement in medication compliance and in knowledge between the first and last consultations (p < 0.05). In the final consultation, 70.37% of the patients showed compliance, with a knowledge rate of 98.35% (SD = 3.63). Non-compliant individuals presented a greater tendency to hospital readmissions. There was no relationship between medication compliance and sociodemographic variables, graft-versus-host disease, and knowledge about pharmacotherapy. CONCLUSIONS: Pharmacotherapeutic follow-up contributed to improving medication compliance. Knowledge about pharmacotherapy alone does not translate into behaviors, which corroborates the complexity of the biopsychosocial factors associated with medication compliance.
Assuntos
Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Adolescente , Adulto Jovem , Humanos , Seguimentos , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Doença Enxerto-Hospedeiro/tratamento farmacológico , Doença Enxerto-Hospedeiro/prevenção & controle , Doença Enxerto-Hospedeiro/etiologia , Adesão à Medicação , Preparações Farmacêuticas , Estudos RetrospectivosRESUMO
Abstract Objectives: describe the profile of medication use and adherence, and the association with clinical and sociodemographic characteristics of high-risk pregnant women attended at a university hospital. Methods: cross-sectional study with data collected through a questionnaire applied on 386 pregnant women. Results: most participants were seen only by the gynecologist (75.1%), started prenatal in the first gestational trimester (86.8%), did not plan the pregnancy (61.9%), and performed an average of 8.2 (SD=4.4) prenatal consultations. The most frequent diagnoses were arterial hypertension (20.5%) and diabetes mellitus (19.7%). Prevalence of medication use was 99.7%, with an average of 5.1 (SD=2.1) medication per woman and 12.7% self-medication. Antianemics (88.9%) and analgesics (63.2%) were the most prevalent classes and 17.9% of the women reported the use of medication with significant gestational risk. Only 36.5% were considered adherent, 32.9% declared they were unaware of the indication of the medication in use and 42% did not receive guidance on the use of the medication during pregnancy. There is no evidence of association between the number of the medication used and clinical and sociodemographic aspects. Conclusions: there is a need to develop strategies to improve the care of this population, with emphasis on strengthening multi-professional care.
Resumo Objetivos: descrever o perfil de utilização de medicamentos e de adesão, e a associação com as características clínicas e sociodemográficas de gestantes de alto risco atendidas em um hospital universitário. Métodos: trata-se de um estudo transversal com dados coletados mediante um questionário estruturado aplicado à 386 gestantes. Resultados: a maior parte das participantes era acompanhada apenas pelo ginecologista (75,1%), iniciou o pré-natal no primeiro trimestre gestacional (86,8%), não planejou a gravidez (61,9%) e realizou em média 8,2 (DP=4,4) consultas de pré-natal. Os diagnósticos mais frequentes foram hipertensão arterial (20,5%) e diabetes mellitus (19,7%). A prevalência de uso de medicamentos foi 99,7%, com média de 5,1 (DP=2,1) medicamentos por mulher e 12,7% de automedicação. Os antianêmicos (88,9%) e analgésicos (63,2%) foram as classes farmacológicas mais prevalentes e 17,9% das gestantes referiram uso de fármacos com risco gestacional relevante. Apenas 36,5% das gestantes foram consideradas aderentes ao tratamento, 32,9% declararam desconhecer a indicação dos medicamentos em uso e 42% não receberam orientações sobre o uso de medicamentos durante a gestação. Não há evidências de associação entre o número de medicamentos utilizados e os aspectos clínicos e sociodemográficos. Conclusão: é necessário desenvolver estratégias para melhorar o atendimento desta população e o uso racional de medicamentos, com ênfase no fortalecimento do cuidado multiprofssional.
Assuntos
Humanos , Feminino , Gravidez , Farmacoepidemiologia/métodos , Gravidez de Alto Risco/efeitos dos fármacos , Uso de Medicamentos , Fatores Sociodemográficos , Brasil , GestantesRESUMO
INTRODUCTION: This systematic review aimed to assess antibiotic use in Brazilian hospitals in the 21st century, as well as to understand the different drug utilization metrics adopted to assess the consumption of these drugs. METHODS: We systematically reviewed five databases (MEDLINE [Medical Literature Analysis and Retrieval System Online], CENTRAL [The Cochrane Central Register of Controlled Trials], EMBASE® [Excerpta Medica Database], Scopus [Elsevier's abstract and citation database], and LILACS [Literatura Latino-Americana e do Caribe em Ciências da Saúde]) for observational or experimental studies that assessed antibiotic utilization in Brazilian hospitals. The main outcomes were the drug utilization metrics and the consumption of antibiotics. RESULTS: We included 23 studies, of which 43.5% were carried out in adult and pediatric care units, 39.1% in adult units, and 17.4% in pediatric units. Regarding the complexity of healthcare, 26.1% of the studies were performed in intensive care units. Two drug utilization metrics were used in these studies: the defined daily dose (DDD) and the percentage of antibiotic prescriptions. The most commonly used antibiotic classes were third-generation cephalosporins, carbapenems, fluoroquinolones, and combinations of penicillins when the DDD was the adopted drug utilization metric. CONCLUSIONS: Although few studies have been conducted, existing data indicate a high use of broad-spectrum antibiotics. We found that the lack of standardized antibiotic utilization metrics impaired the mapping of drug consumption at the national level.
Assuntos
Antibacterianos , Penicilinas , Adulto , Antibacterianos/uso terapêutico , Brasil , Carbapenêmicos , Criança , Hospitais , HumanosRESUMO
BACKGROUND: Stroke accounts for approximately as 5.0% of disability-adjusted years of life and 10.0% of all deaths worldwide. Secondary stroke prevention in surviving individuals, which includes the use of statins, reduces atherothrombotic stroke recurrence, complications and mortality. The present study aimed to characterize the Brazilian population with stroke history and estimate the prevalence of statin use as secondary prevention. METHODS: This is a population-based cross-sectional study conducted in Brazilian urban areas. A total of 41.433 individuals were interviewed, representing 171 million of Brazilians, based on post-stratification weights. We included only participants aged 20 years or older who answered "yes" to the following question: "Did any doctor ever tell you that you had a stroke?" The main outcome was the prevalence of statin use among individuals who answered affirmatively. To identify the factors associated with stroke occurrence, the participants were categorized according to clinical and sociodemographic characteristics. RESULTS: Only 24.2% (95% CI 19.9 - 29.1) of those who reported history of stroke regardless of other conditions also reported statin use. However, the results indicated that 52.9% (95% CI 43.6 - 62.0) of individuals who reported a previous diagnosis of dyslipidemia stated the use of statins. Regarding patients who reported stroke and did not report dyslipidemia history, only 9.1% (95% CI 5.9 - 13.8) referred to use statins. CONCLUSION: This study showed a low prevalence of statin use by individuals with a history of stroke in Brazil. Actions involving the organization of services and training of professionals may positively impact the rates of stroke recurrence.
Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Padrões de Prática Médica/tendências , Prevenção Secundária/tendências , Acidente Vascular Cerebral/prevenção & controle , Adulto , Idoso , Brasil/epidemiologia , Estudos Transversais , Uso de Medicamentos/tendências , Medicina Baseada em Evidências/tendências , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Proteção , Recidiva , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Introduction: Pharmacotherapy is the main therapeutic resource for the management of diseases. However, the number of drugs prescribed, dose frequency, and mode of administration can make the treatment more complex and influence treatment outcomes. The aim of this study was to measure the complexity of prescribed medication regimens in primary health care (PHC) services in Ribeirão Preto, Brazil. Methods: This cross-sectional study included 1,009 participants: 889 from primary health units and 120 from family health units in Ribeirão Preto, Brazil. Treatment complexity was assessed using the Medication Regimen Complexity Index (MRCI). Results: MRCI mean scores were 12.5 points (SD = 9.3) and dose frequency was the major contributor to increase the score. The complexity of pharmacotherapy showed a significant correlation with the number of prescribed medications (r = 0.93, p < 0.01), but not with patients' age (r = 0.28, p < 0.01). There is also no difference in complexity between the sexes (p = 0.83) and the types of primary health care service (p = 0.31). An analysis of variance revealed that patients with lower levels of education receive more complex prescriptions (p < 0.01). Conclusions: The pharmacotherapy prescribed in PHC services from Ribeirão Preto, Brazil is complex, and there is a need to concentrate efforts and adopt strategies to simplify drug prescription without compromising patient's clinical status.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Prescrições de Medicamentos , Atenção Primária à Saúde , Formas de Dosagem , Quimioterapia Combinada , Adesão à Medicação , Fatores Socioeconômicos , Estudos Transversais , Resultado do TratamentoRESUMO
Objetivo: Este estudo transversal visa analisar comparativamente as prescrições de medicamentos provenientes da atenção básica tradicional (Unidades Básicas de Saúde - UBS) com as da Estratégia de Saúde da Família (ESF). Métodos: Foram incluídas 1053 prescrições, alocadas em dois grupos: 932 provenientes de UBS e 121 da ESF. Tais prescrições foram analisadas de acordo com a adequação aos itens legalmente exigidos e aos indicadores de qualidade (presença de antimicrobianos, presença de injetáveis, uso da denominação oficial, uso da relação de medicamentos essenciais, média de medicamentos prescritos). Resultados: As prescrições da ESF se mostraram estatisticamente mais completas quanto à presença do endereço do prescritor (82,6% UBS, 96,7% ESF), à ausência de rasuras (90,3% UBS, 96,7% ESF) e ao cumprimento dos aspectos legais exigidos referentes ao uso do medicamento, sendo eles: forma farmacêutica (70,7% UBS, 80,2% ESF), dose (70,9% UBS, 79,3% ESF), posologia (63,0% UBS, 75,2% ESF), via de administração (58,3% UBS, 83,5% ESF) e duração do tratamento (76,9% UBS, 92,6% ESF). Os resultados dos indicadores de qualidade da prescrição se aproximaram nos dois modelos de atenção básica e estão de acordo com os valores recomendados, com exceção da média de medicamentos prescritos, a qual evidenciou uma tendência à polifarmácia no município (3,9 medicamentos por prescrição na UBS e 3,5 na ESF). Conclusão: Apesar dos resultados revelarem práticas inapropriadas na prescrição de medicamentos na Atenção Primária como um todo, há evidências de que as prescrições da ESF estão mais próximas ao padrão ideal, o que pode favorecer o Uso Racional de Medicamentos.
Objective: This cross-sectional study aims to comparatively analyze drug prescriptions from the traditional basic health care service (Basic Health Units - BHU) with those from Family Health Strategy (FHS). Methods: A total of 1053 prescriptions were included, allocated in two groups: 932 from BHU and 121 from FHS. These prescriptions were analyzed according with compliance to legally required items and quality indicators (presence of antimicrobials, presence of injectable, use of the official name, use of the list of essential drugs, average of drugs prescribed). Results: The ESF prescriptions were more complete regarding the presence of the prescriber's address (82.6% BHU, 96.7% FHS), the absence of erasures and overwritten words (90.3% BHU, 96.7% FHS) and with compliance to legally required items related to use of drugs, being: pharmaceutical form (70.7% BHU, 80.2% FHS), dose (70.9% BHU, 79.3% FHS), posology (63.0% BHU, 75.2% FHS), administration route (58.3% BHU, 83.5% FHS) and time of therapy (76.9% BHU, 92.6% FHS). The results of the indicators of quality of prescription are approximated in both models of basic attention and according to the recommended values, with the exception of the average of drugs prescribed, which showed a tendency to polypharmacy at county (3.9 drugs per prescription at the BHU and 3.5 at the FHS). Conclusion: although the results reveal inappropriate practices in drug prescription at Primary Health Care services as a whole, there are evidence that prescriptions from FHS are closer to the ideal pattern, which may favor the Rational Use of Drugs.
Objetivo: Este estudio transversal tuvo como objetivo comparar prescripciones médicas de la atención primaria tradicional (Unidades Básicas de Salud - UBS) con las de la Estrategia de Salud Familiar (ESF). Métodos: Se incluyeron 1053 prescripciones, divididas en dos grupos: 932 de la UBS y 121 de la ESF. Estas prescripciones se analizaron de acuerdo con la adecuación de los ítems legalmente requeridos y a los indicadores de calidad (presencia de antimicrobianos, presencia de inyectables, uso de la denominación oficial, uso de la relación de medicamentos esenciales, número medio de los medicamentos prescritos). Resultados: Las prescripciones de la ESF eran estadísticamente más completas debido a la presencia de la dirección del prescriptor (82,6% UBS, 96,7% ESF), en la ausencia de tachaduras (90,3% UBS, 96,7% ESF) y en el cumplimiento de los aspectos legales requeridos referentes al uso del medicamento, siendo ellos: forma farmacéutica (70,7% UBS, 80,2% ESF), dosis (70,9% UBS, 79,3% ESF), posología (63,0% UBS, 75,2% ESF), vía de administración (58,3% UBS, 83,5% ESF) y duración del tratamiento (76,9% UBS, 92,6% ESF). Los resultados de los indicadores de calidad de la prescripción fueron similares en los dos modelos de atención primaria y están de acuerdo con los valores recomendados, excepto el número medio de los medicamentos prescriptos, que mostró una tendencia a la polifarmacia en el municipio (3,9 medicamentos por prescripción en la UBS y 3,5 en la ESF). Conclusión: Aunque los resultados indican prácticas inadecuadas en la prescripción de medicamentos en atención primaria en general, existen evidencias de que las prescripciones de la ESF son más cercanas a los estándares, lo que puede favorecer el Uso Racional de Medicamentos.
Assuntos
Prescrições de Medicamentos , Atenção Primária à Saúde , Estudos TransversaisRESUMO
Objetivo: identificar a aplicabilidade do Exame Clínico Objetivo Estruturado como ferramenta de avaliação educacional e de competência clínica de discentes de graduação da saúde. Método: trata-se de revisão integrativa da literatura em que foram realizadas buscas em três bases de dados, no período de 2010 a 2015. Resultados: selecionaram-se 12 manuscritos, que foram categorizados em dois grupos: Exame Clínico Objetivo Estruturado como método efetivo e válido para a avaliação da competência clínica dos discentes na simulação da prática, e Exame Clínico Objetivo Estruturado como avaliação preditiva do desempenho do estudante na prática clínica. Conclusão: evidenciou-se que o Exame Clínico Objetivo Estruturado é reconhecido como estratégia válida para avaliar a competência clínica no processo de ensino-aprendizagem, apresentando benefícios significativos, entretanto, as limitações associadas ao exame também são reconhecidas.
Objetivo: identificar la aplicabilidad del Examen Clínico Objetivo Estructurado como herramienta de evaluación educativa y de competencia clínica de discentes de graduación de la salud. Método: se trata de revisión integrativa de la literatura en que se realizaron búsquedas en tres bases de datos, en el período de 2010 a 2015. Resultados: se seleccionaron 12 manuscritos, que fueron categorizados en dos grupos: Examen Clínico Objetivo Estructurado como método efectivo y válido para la evaluación de la competencia clínica de los discentes en la simulación de la práctica, y el Examen Clínico Objetivo Estructurado como evaluación predictiva del desempeño del estudiante en la práctica clínica. Conclusión: se evidenció que el Examen Clínico Objetivo Estructurado se reconoce como estrategia válida para evaluar la competencia clínica en el proceso de enseñanza-aprendizaje, presentando beneficios significativos, sin embargo, las limitaciones asociadas al examen también son reconocidas.
Objective: to identify the applicability of the Objective Structured Clinical Exam as a tool to evaluate the educational and clinical competence of undergraduate students in the healthcare area. Method: comprehensive review of the literature in which three databases were searched from 2010 to 2015. Results: 12 manuscripts were selected and categorized into two groups: Objective Structured Clinical Exam as an effective and valid method for the evaluation of the students' clinical competence in the practice simulation, and Objective Structured Clinical Exam as a predictive evaluation of student performance in clinical practice. Conclusion: it was evidenced that the Objective Structured Clinical Exam is recognized as a valid strategy to evaluate clinical competence in the teaching-learning process with significant benefits. However, the limitations associated with the exam are also recognized.
Assuntos
Humanos , Exercício de Simulação , Competência Clínica , Avaliação Educacional , Revisão , Aprendizagem Baseada em Problemas , UniversidadesRESUMO
Aquatic environments often receive wastewater containing pollutants such as antibiotics and heavy metals from hospital sewage, as well as contaminants from soil. The presence of these pollutants can increase the rate of exchange of resistant genes between environmental and pathogenic bacteria, which can make the treatment of various types of bacterial infections in humans and animals difficult, in addition to causing environmental problems such as ecological risk. In this study, two tetracycline-resistant Pseudomonas aeruginosa (EW32 and EW33), isolated from aquatic environments close to industries and a hospital in southeastern Brazil, were investigated regarding the possible association between tetracycline and heavy metal resistance. The isolate EW32 presented a conjugative plasmid with coresistance to tetracycline and copper, reinforcing the concern that antibiotic resistance by acquisition of plasmids can be induced by the selective pressure of heavy metals in the environment.