Antimicrobial use in long-term care facilities: the participation of nurses / Indicação de antimicrobianos em instituições de longa permanência: participação do enfermeiro

Objective: To identify how antimicrobials are prescribed in long-term care facilities from the perspective of nurses. Methods: This descriptive study was conducted using an online survey. Participants were selected through conventional sampling methods and online recruitment. Data were collected through a 2-section self-administered questionnaire: the first section characterized the respondent and the institution, while the second investigated the antimicrobial prescription and usage in the institution. Results: Thirty-five responses were received, representing institutions from every state in Brazil. Sixty percent of the institutions had a part-time physician. More than 90% of the respondents said they contacted a prescriber to report signs and symptoms suggestive of infection, which led to subsequent antimicrobial use. Conclusions: The opinion of nurses has a significant impact on the prescriber's decision to begin antibiotic therapy in long-term care facilities, which indicates that nurses need training about the rational use of antimicrobials. (AU)

Objetivo: Identificar como ocorre a indicação de antimicrobianos nas instituições de longa permanência na perspectiva do profissional enfermeiro. Metodologia: Foi realizado um estudo descritivo por meio de um Survey online. Os participantes foram selecionados por meio de amostra convencional e o recrutamento foi realizado por meio de convite online. A coleta de dados foi feita a partir de um questionário autoaplicável constituído de dois blocos: o primeiro contemplando itens para a caracterização do respondente e da instituição; e o segundo, questões relacionadas ao uso e à indicação de antimicrobianos na instituição. Resultados: Foram recebidas 35 respostas, representando instituições de todos os estados brasileiros. A presença de médico em tempo parcial foi apontada em 60% das instituições. Mais de 90% dos participantes apontaram que acontecia o contato com prescritor para o relato de sinais e sintomas sugestivos de infecção apresentados pelo residente, implicando em uso subsequente de antimicrobianos. Conclusões: A opinião do profissional da Enfermagem tem grande impacto na decisão do prescritor em iniciar a antibioticoterapia nas instituições de longa permanência, demonstrando a necessidade de qualificação desse profissional direcionada ao uso racional de antimicrobianos. (AU)

Consenso latinoamericano sobre la importancia de un sistema de gestión de datos microbiológicos para apoyar el programa de optimización de uso de antimicrobianos (PROA): Recomendaciones basadas en la evidencia. Parte 1 / Latin American consensus on the importance of a microbiological data management system to support antimicrobial use optimization program (PROA): Evidence-based recommendations. Part 1

La resistencia antimicrobiana es una amenaza para los logros de la medicina moderna y una de las medidas más efectivas para contrarrestarla son los programas de optimización del uso de antimicrobianos (PROA), en el cual el laboratorio de microbiología es uno de los principales componentes. La aplicación efectiva de tecnología de la información en los procesos es fundamental, pero existe poca información en Latinoamérica sobre el desarrollo y la articulación de las herramientas tecnológicas para apoyar los PROA. Este consenso hace recomendaciones sobre la gestión de los datos microbiológicos para la toma de decisiones. En la Parte I, se presentan las recomendaciones en cuanto al uso de un sistema informatizado de gestión de datos microbiológicos en la práctica clínica, los requerimientos de datos y de reporte en el laboratorio de microbiología, y los contenidos del sistema de gestión de calidad avanzado en el laboratorio. En la Parte II, se discuten los requerimientos de información para la gestión de PROA en estadios intermedios, iniciales y avanzados por el laboratorio y la farmacia; así como la integración del equipo de PROA con el Comité de Prevención y Control de Infecciones y la información para la gestión de PROA a nivel gerencial.

Antimicrobial resistance is a threat to the achievements of modern medicine and one of the most effective measures to counteract it is antimicrobial use optimization programs (AMS), in which the microbiology laboratory is one of the main components. The effective application of information technology in the processes is fundamental, but there is little information in Latin America on the development and articulation of technological tools to support AMSs. This consensus makes recommendations on the management of microbiological data for decision making. In Part I, recommendations on the use of a computerized microbiological data management system in clinical practice, data and reporting requirements in the microbiology laboratory, as well as the contents of the advanced quality management system in the laboratory are presented. In Part II, the information requirements for AMS management in intermediate, initial, and advanced stages by the laboratory and pharmacy are discussed; as well as the integration of the AMS team with the Infection Prevention and Control Committee and the information for AMS management at the management level.

Estimation of antimicrobial costs in cases of surgical site infection / Estimación de los costes antimicrobianos en casos de infección del sitio quirúrgico / Estimativa dos custos com antimicrobianos em casos de infecção de sítio cirúrgico

Objective: To estimate the costs of antimicrobials in patients with surgical site infections (SSI). Method: This is a descriptive, cross-sectional study with retrospective documentary analysis conducted at a tertiary public hospital with seven surgical rooms, averaging 750 surgeries per month.The micro-costing method used was the average direct cost of antibiotics, excluding intraoperative prophylactic antibiotics. Hospital infection investi-gation records were analyzed, and the study included records of patients diagnosed with confirmed surgical site infections (n=79) in 2021. Clinical data and direct costs of antimicrobials were examined. Results: The infection rate in this study was 6.76%. The specialties with the highest representation were digestive system and urological surgeries. Vancomycin was the most used antimicrobial, resulting in a total expenditure of R$ 7,345.68. Tigecycline incurred the highest total cost, amounting to R$ 79,655.52. Antimicrobials used to treat the 79 confirmed cases of SSIs totaled R$ 211,790.21 in costs. Conclusion: The average cost of antimicrobials per patient with SSI, considering total hospitalization days, was R$ 2,680.88, a significant component of total treatment costs. It is recommended to include cost analysis in the planning of hospital infection protocols. (AU)

Objetivo: Estimar los costos de los antimicrobianos en pacientes con infecciones del sitio quirúrgico (ISQ). Método: Este es un estudio descrip-tivo, transversal con análisis documental retrospectivo realizado en un hospital público terciario con siete salas quirúrgicas, con un promedio de 750 ciru-gías por mes. Se utilizó el método de microcosteo, calculando el costo directo promedio de los antibióticos, excluyendo los utilizados como profilaxis intraoperatoria. Se analizaron registros de investigación de infecciones hospitalarias, incluyendo pacientes diagnosticados con ISQ confirmadas (n=79) en 2021. Se examinaron datos clínicos y costos directos de los antimicrobianos. Resultados: La tasa de infección en este estudio fue del 6.76%. Las espe-cialidades con mayor representación fueron cirugías del sistema digestivo y urológicas. El antimicrobiano más utilizado fue la vancomicina, con un gasto total de R$ 7,345.68. Tigeciclina tuvo el costo total más alto, alcanzando R$ 79,655.52. Los antimicrobianos utilizados para tratar los 79 casos confirma-dos de ISQ sumaron R$ 211,790.21 en costos. Conclusión: El costo promedio de los antimicrobianos por paciente con ISQ, considerando los días totales de hospitalización, fue de R$ 2,680.88, un componente significativo de los costos totales de tratamiento. Se recomienda incluir análisis de costos en la planificación de protocolos de infección hospitalaria. (AU)

Objetivo: Estimar os custos com antimicrobianos em pacientes com infecções de sítio cirúrgico. Método: Trata-se de um estudo descritivo, trans-versal, com análise documental retrospectiva, realizado em um hospital público terciário, com sete salas cirúrgicas, onde se realizam em média 750 cirur-gias mensais. O método de microcusteio utilizado foi o custo direto médio dos antibióticos, não sendo incluído antibiótico profilático no intraoperatório. Analisaram-se as fichas de investigação de infecção hospitalar e foram incluídas no estudo as fichas de pacientes que tiveram o diagnóstico de infecção de sítio cirúrgico confirmado (n=79) em 2021. Foram verificados os dados clínicos e apenas os custos diretos com os antimicrobianos. Resultados: A taxa dessas infecções neste estudo foi de 6,76%. As especialidades com maior representatividade foram cirurgias do aparelho digestivo e urológicas. O antimi-crobiano mais utilizado foi a Vancomicina, resultando no gasto total de R$ 7.345,68. O medicamento que gerou maior custo total foi a Tigeciclina, que representou R$ 79.655,52. Os antimicrobianos utilizados para tratar dos 79 casos confirmados de ISCs totalizaram o custo de R$ 211.790,21. Conclusão: A média de custo com antimicrobiano por paciente com ISC, no total de dias internados, foi de R$ 2.680,88, valor considerado representativo no custo total do tratamento. Recomenda-se a inclusão de análise de custos no planejamento de protocolos de infecção hospitalar. (AU)

Determination of the enablers and challenges in the implementation of pharmacy-based Antimicrobial Stewardship (AMS) Program in a level 3 hospital in Manila

Background and Objectives@#Antimicrobial resistance (AMR) is a global public health threat that results from misuse and overuse of antimicrobials. The Department of Health (DOH) institutionalized the Antimicrobial Stewardship (AMS) Program in hospitals, based on the core elements (1) Leadership, (2) Policies, Guidelines, and Pathways, (3) Surveillance Antimicrobial Use (AMU) & AMR, (4) Action, (5) Education, and (6) Performance Evaluation to ensure rational use of antimicrobials and improve patient outcomes. The program implementation will require the involvement of the AMS clinical pharmacist to positively influence the success of the program’s implementation. This study aims to identify the enablers and challenges as perceived by AMS clinical pharmacists in the implementation of an AMS program in a level 3 hospital in Manila.@*Methods@#A quantitative descriptive study design was employed by administering an online 50-item survey questionnaire to AMS pharmacists, who have at least six (6) months of experience as an AMS pharmacist in the hospital. The survey questionnaire was validated by an expert consultant and underwent pre-testing (Cronbach α = 0.983) for acceptable internal consistency. Responses were collated, coded, and analyzed using median values and frequency distributions for each questionnaire item per Department of Health (DOH) Core Element. Items garnering a median of >3.50 up to 5 were considered as perceived enablers, while those ≤3.50 were identified as perceived challenges.@*Results@#Some perceived enablers by the AMS pharmacists include presence of a leader and/or clinician in the AMS team, Information Technology (IT) resource availability, clear roles of AMS pharmacists, readily available hospital AMS guidelines, engagement in AMR and AMU surveillance activities, regular performance of AMS interventions (e.g., IV-to-PO conversion, dose optimization, de-escalation of broad spectrum), regular monitoring and evaluating of prescriptions and prescribing behavior, and continuous education on infection, prevention, and control (IPC) and hygiene. On the other hand, some perceived challenges include insufficient funding, inadequate knowledge in interpreting antibiograms, lack of adequate and specialized training sessions, lack of coordination with medical and nursing staff to ensure timely drug administration and automatic stop order, prescribing of non-Philippine National Formulary (PNF) antimicrobials, lack of time to perform AMS activities, lack of qualified personnel, and lack of hospital management and information technology (IT) support.@*Conclusion@#Empowering AMS clinical pharmacists is vital to addressing the perceived challenges and maximizing the perceived enablers to ensure the successful implementation of the AMS program in the hospital.

Drug utilization review of monitored parenteral antimicrobials in a Tertiary Care Private Hospital in Cebu City

Background@#Based on the 2017-2020 annual report of the Department of Health-Antimicrobial Resistance Surveillance Program, significant resistance patterns have been observed for common disease-causing pathogens. In the hospital setting, antimicrobial stewardship programs have been implemented to optimize the use of antimicrobials. Drug utilization review studies provide essential feedback to improve prescribing and use of medications.@*Objectives@#This study aimed to review drug utilization of monitored parenteral antimicrobials among patients admitted from January to December 2019.@*Methods@#The study employed a retrospective, cross-sectional, descriptive research design. A retrospective chart review of drugs administered to patients was conducted.@*@#Results. A total of 821 patients charts met the inclusion criteria. The patients’ ages ranged from 18 to 98 years old and 52% were females. General Internal Medicine practitioners (28%) were the top prescribers of monitored parenteral antimicrobials primarily for the management of moderate-risk community-acquired pneumonia (39%). They were mostly indicated for empirical treatment of infections (94%) and were given for an average of 5.73 days. Only 58% of the total cases had orders for culture and sensitivity testing. Of which, principally 47% had colony cultures. Blood (29%) and sputum (27%) were the most common specimens taken for culture and sensitivity testing. The microorganisms often isolated were Escherichia coli (19%), Klebsiella pneumoniae (18%), and Staphylococcus aureus (9%). In addition, extended-spectrum beta lactamase-producing gram-negative pathogens (4%) and methicillin-resistant S. aureus (1%) were also isolated. All the microorganisms isolated showed most resistance to ampicillin (81%) and most susceptibility to colistin (100%). There were drug therapy-related problems encountered. There was one case of an adverse drug reaction (0.1%) and two cases of contraindications (0.2%). Therapeutic duplication was also observed in 5% of the cases. Moreover, 39% had instances of drug-drug interactions.Piperacillin-tazobactam had the highest consumption (79.50 defined daily doses/1,000-patient days) among the monitored parenteral antimicrobials. Some prescriptions were deemed inappropriate upon evaluation. 12% of cases were inappropriate based on the justification indicator. As for the critical indicators, duration of therapy (78%) was the main reason. Only four components of the DUE criteria indicators have met or exceeded the established threshold level.The cost analysis indicated that the total actual cost of therapy with the monitored parenteral antimicrobials amounted to ₱17,645,601.73. Considering Department of Health National Antibiotic Guidelines recommenda-tions, ideal total cost of treatment was ₱14,917,214.29. Potential cumulative cost savings of ₱2,728,387.44 could have been achieved for patients admitted last 2019.@*Conclusion@#Consumption of piperacillin-tazobactam was relatively high as compared to the other monitored parenteral antimicrobials covered in this study. Physicians at the study site seldom prescribe monitored parenteral antimicrobials as recommended by the National Antibiotic Guidelines. This is evidenced in the incidence of inappropriate therapy regimens, with inapt duration of therapy as the leading explanation.From the patient’s perspective, the main economic implication was on the direct medical costs, particularly the increased cost of the actual antimicrobial therapy prescribed to manage various infections. Adherence of physicians to the established guidelines and selection of the most cost-effective therapy could have resulted in considerable cost savings.

Antimicrobial stewardship: Attitudes, perceptions, and practices of healthcare workers in a pediatric tertiary hospital

Objectives@#This study aims to determine the healthcare workers’ (HCWs) attitudes, perceptions, and practices regarding Antimicrobial Stewardship (AMS) at the Philippine Children's Medical Center (PCMC).@*Materials and Methods@#This cross-sectional study employed a validated online survey. @*Results@#The study included 288 healthcare workers, predominantly female (77.35% ) and aged 31-40 years (47.74%), with physicians being the largest professional group (57.14%). HCWs had positive attitudes toward AMS. They perceived moderate to high antimicrobial resistance (AMR) levels in different contexts but believed the hospital had lower AMR levels than the country. HCWs agreed that AMR impacts antimicrobial choices, patient outcomes, and safety. Contributors to AMR were prescribing inappropriate antimicrobials, unnecessary prescriptions, poor patient adherence, and inadequate infection control measures. HCWs, except medical technologists, were aware of the Antimicrobial Stewardship Program (ASP) and its interventions. Only nurses and pharmacists were aware of the hospital policies against AMR. Barriers to AMS implementation include inadequate training in antimicrobial use, lack of infectious disease/ microbiology services, lack of electronic medication management services, and personnel shortages. HCWs had high self-reported AMS practices, but a practice gap in single-dose surgical antibiotic prophylaxis was identified, with low physician adherence (50.6%).@*Conclusion@#This study revealed positive attitudes and high self-reported AMS practices among HCWs. They also perceived moderate to high AMR in different contexts but believed that the hospital has lower AMR levels than the country. Addressing the identified barriers to implementation and practice gaps is crucial for achieving antimicrobial stewardship goals.

Implementación de un programa para mitigar la resistencia a los antimicrobianos en escenarios de bajos recursos / Implementation of a program to face antimicrobial resistance on a low resources hospital

Estudio cuasi-experimental desarrollado para disminuir el impacto de la resistencia a los antimicrobianos a través de un programa de prevención de infecciones y optimización del uso de antimicrobianos construido "a medida" según las posibilidades de la institución. Se implementó: vigilan-cia de colonización e infección por enterobacterias pro-ductoras de carbapenemasas (EPC); vigilancia y medidas preventivas para infecciones urinarias asociadas a sonda vesical (ITU); vigilancia e intervenciones para mejorar la higiene de manos; guías locales de tratamiento de enfer-medades infecciosas con evaluación de adherencia a las mismas y consumo de antibióticos (ATB). Resultados: Comparando periodo pre y postintervención: tasa de EPC en muestras clínicas: 1,1 a 0/días paciente; razón de tasas de incidencia (IRR: 0.00, p: 0.033); tasa de colonización: 3,3 a 0,61/días paciente (IRR: 0.18, p: 0.5). Tasa de ITU 8,9 a 7,2/1000 días catéter urinario (IRR: 0.81, p 0.5). Adherencia a higiene de manos: 77,5% a 70,38% (p 0.0067). Consumo de ATB: 376,24 a 176,82 DDD, (disminu-ción 53%). Adherencia a guías en elección de ATB: 57,1% a 95,4% (p 0.00031); duración de ATB: 92,8% a 98,4% (p 0.16); adecuación según rescate microbiológico: 57,1% a 100% (p <0.01). Conclusión: Un programa con medidas simples, a medida, con supervisión externa, redujo en un tiempo relativamente corto las infecciones por EPC, el consumo y uso apropiado de ATB en un hospital público de medianos/bajos recursos

This quasi-experimental study was developed in a public hospital with the goal of reducing the impact of antimicrobial resistance through an infection prevention and antimicrobial stewardship program. The following measures were implemented: surveillance of colonization and infection by carbapenemase-producing Enterobacteriaceae (CPE); surveillance and preventive measures for urinary catheter-associated infections (UTIs); surveillance and interventions for hand hygiene; local guidelines for treatment of infectious diseases with compliance and antibiotic (ATB) consumption metrics.Results: comparing the pre-intervention and post-intervention period, CPE rate in clinical samples 1.1 to 0/patient days, incidence rate ratio (IRR): 0.00, p: 0.033 and colonization of 3.3 to 0.61/days patient, IRR: 0.18, p-value: 0.5. UTI rate 8.9 to 7.2/1000 days urinary catheter IRR: 0.81, p 0.5. Hand Hygiene compliance: 77.5% to 70.38%, p 0.0067. ATB consumption: 376.24 to 176.82 DDD, 53% decrease. Compliance to guidelines in ATB selection: 57.1% to 95.4% p 0.00031, duration of ATB from 92.8% to 98.4% p 0.16, and adequacy to microbiological rescue of 57.1% at 100%, p <0.01. Conclusion: it is possible to reduce CPE infections, the consumption of antimicrobials and optimize their use in a public hospital in a country with medium/low resources through a program with basic and tailored measures

Infectious disease evaluations in a psychiatric unit, an observational study / Visitas infectológicas a una unidad psiquiátrica, un estudio observacional

Patients in adult psychiatric wards present infectious complications or pathologies that mimic an infectious condition, and there is little information on this subject. OBJECTIVES: To know the frequency and infectious and non-infectious complications treated by infectious disease specialists in a psychiatric intensive-care hospitalization unit for adults and their outcomes. METHODS: Observational study between 2016 and 2021. RESULTS: 37 patients with 41 events were evaluated. Almost half of the visits to these events originated from an antimicrobial stewardship program (46.3%). In 68.3% of the events, complementary studies were requested; in 14.6%, referral to other specialties; in 26.8%, an antimicrobial treatment was started; and in 75%, modifications were made to previous schemes. An infectious cause was identified in 30 of 41 events (73.2%) that included the following conditions: respiratory (31.7%), skin (9.8%), urinary (7.3%), gynecological (2.4%), one case of bacteremia with unknown source (2.4%), sequential infections (4.9%) and HIV therapy dropouts (7.3%). In the 11 remaining events, non-infectious causes were identified (26.8%): pulmonary thromboembolism, drug hepatotoxicity, false positive VDRL and HIV tests, steroid-induced psychosis in an HIV patient with thrombocytopenia, fever without etiology, residual positive SARS-CoV-2 PCR test, low O2 pulse oximetry due to oversedation and neuroleptic malignant syndrome. There was no mortality. CONCLUSIONS: Patients in psychiatric hospitalization wards suffer from a great diversity of infectious problems during their stay with conditions that simulate infections. An antibiotic surveillance system can detect half of these conditions. The infectious diseases visits allow for advising or reorienting of the study and modifying the antibiotic treatment.

Los pacientes en salas de hospitalización psiquiátricas de adultos presentan complicaciones infecciosas o patologías que simulan un cuadro infeccioso y existe escasa información sobre este tema. OBJETIVOS: Conocer la frecuencia y tipo de complicaciones infecciosas y no infecciosas atendidas por especialistas de infectología en un Servicio de hospitalización psiquiátrica de cuidados intensivos de adultos y sus desenlaces. MÉTODOS: Estudio observacional entre el 2016 y 2021. RESULTADOS: Se visitaron 37 paciente con 41 eventos. Casi la mitad de las visitas en estos eventos se originó por seguimiento de antimicrobianos (46,3%). En el 68,3% de los eventos se solicitaron estudios complementarios, en 14,6% la opinión de otras especialidades, en 26,8% se inició un tratamiento antimicrobiano y en 75% se hicieron modificaciones a esquemas previos. En 30 de 41 eventos se identificó una causa infecciosa (73,2%) que incluyeron las siguientes condiciones: respiratorias (31,7%), cutáneas (9,8%), urinarias (7,3%), ginecológicas (2,4%), bacteremia sin foco (2,4%), infecciones secuenciales (4,9%) y abandonos de terapia en pacientes VIH (7,3%). En los 11 eventos restantes se identificaron causas no infecciosas (26,8%): tromboembolismo pulmonar, hepatotoxicidad por drogas, test VDRL y VIH falsos positivos, psicosis por esteroides en un paciente VIH con trombocitopenia, fiebre sin etiología, PCR SARS-CoV-2 positiva residual, desaturación de O2 por sedación y síndrome neuroléptico maligno. No hubo mortalidad en esta serie. CONCLUSIONES: Los pacientes en salas de hospitalización psiquiátrica sufren de una gran diversidad de problemas infecciosos durante su estadía junto a cuadros que simulan infecciones. Un sistema de vigilancia antibiótica permite detectar la mitad de estas condiciones. Las visitas infectológicas permiten asesorar o reorientar el estudio y modificar el tratamiento antibiótico.

Intervención educativa para mejorar la prescripción de ceftriaxona en un servicio de urgencias / Educational intervention to improve ceftriaxone prescription in an emergency department

Objetivo: Evaluar prevalencia y adecuación de ceftriaxona tras una intervención educativa en un servicio de urgencias.Métodos: Estudio cuasi experimental que incluyó un mues-treo consecutivo de consultas no programadas de pacien-tes adultos, durante dos meses preintervención y posin-tervención. Dicha intervención consistió en capacitación a médicos para limitar su indicación sólo a situaciones clínicas específicas (meningitis, enfermedad pélvica infla-matoria y abdomen agudo). Se utilizaron datos retrospecti-vos, con adicional revisión manual de historias, para validar adecuación de inicio antibiótico y apropiabilidad de droga. Se utilizó estadística descriptiva y analítica.Resultados: De un total de 28.570 consultas, 512 recibie-ron ceftriaxona (1,79%; IC95% 1,64-1,95), y sólo 60,54% se hospitalizaron. En cuanto a la comparación antes-después, se observó una reducción en la tasa de uso (de 3,66% a 0,63%; p<0,001), la adecuación en el inicio de un antimicro-biano se mantuvo (de 84,52% a 86,21%; p=0,778), aunque la adecuación de ceftriaxona aumentó en forma significativa (de 41,78% a 84,00% respectivamente; p<0,001). Adicional-mente, se redujo el tiempo de estadía hospitalaria (media-na de 6 a 5 días; p=0,014), sin diferencias en la mortalidad intrahospitalaria (19,44% vs 17,24%; p=0,691), ni en la mor-talidad a los 30 días (23,41% vs 18,96%; p=0,464).Conclusiones: Esta intervención resultó eficaz. Los hallaz-gos representan un paso fundamental en los programas de optimización del uso de antimicrobianos hospitalarios, que apuntan a reducir su sobreutilización y la consecuente resistencia.

Objective: To evaluate the prevalence and appropriateness of ceftriaxone after an educational intervention in an emergency department.Methods: Quasi-experimental study, which included a consecutive sampling of unscheduled consultations of adult patients, during 2 months pre-intervention and post-intervention. The intervention consisted of training physicians to limit its indication only to specific clinical situations (meningitis, pelvic inflammatory disease, and acute abdomen). Retrospective data were used, with additional manual chart review, to validate appropriateness of antibiotic initiation and drug appropriateness. Descriptive and analytical statistics were used.Results: Among 28570 visits, 512 received ceftriaxone (1.79%; 95%CI 1.64-1.95), and only 60.54% were hospitalized. Regarding the before-after comparison, we observed a reduction in the rate of use (from 3.66% to 0.63%; p<0.001), the appropriateness in starting an antimicrobial was maintained (from 84.52% to 86.21%; p=0.778), and the appropriateness of ceftriaxone increased significantly (from 41.78% to 84.00% respectively; p<0.001). Additionally, hospital length of stay was reduced (median 6 to 5 days; p=0.014), with no difference in in-hospital mortality (19.44% vs 17.24%; p=0.691), nor in 30-day mortality (23.41% vs 18.96%; p=0.464)

Description of changes in clinical outcomes following the implementation of an antibiotic stewardship program in a level IV hospital / Descripción del cambio en desenlaces clínicos posteriores a la implementación de un programa de gestión de antibióticos en un hospital de cuarto nivel de atención en salud

Introduction. Inadequate prescription of antibiotics has been recognized as a public health problem by the World Health Organization. In this context, antibiotic stewardship programs have been implemented as a tool to mitigate its impact. Objective. To describe the changes in clinical outcomes after the implementation of an antibiotic stewardship program in a level IV hospital. Materials and methods. We conducted a unique cohort study of patients hospitalized for infectious pathologies that were treated with antibiotics in an advanced medical facility. We collected the clinical history before the implementation of the antibiotic stewardship program (2013 to 2015) and then we compared it to the records from 2018 to 2019 collected after the implementation of the program. We evaluated changes in clinical outcomes such as overall mortality, and hospital stay, among others. Results. We analyzed 1,066 patients: 266 from the preimplementation group and 800 from the post-implementation group. The average age was 59.2 years and 62% of the population was male. Statistically significant differences were found in overall mortality (29% vs 15%; p<0.001), mortality due to infectious causes (25% vs 9%; p<0.001), and average hospital stay (45 days vs 21 days; p<0.001); we also observed a tendency to decrease hospital re- admission at 30 days for infectious causes (14% vs 10%; p=0.085). Conclusions. The antibiotic stewardship program implemented was associated with a decrease in overall mortality and mortality due to infectious causes, as well as in average hospital stay. Our results evidenced the importance of interventions aimed at mitigating the impact of inadequate prescription of antibiotics.

Introducción. La inadecuada prescripción de antibióticos es un problema de salud pública, reconocido por la Organización Mundial de la Salud. Los programas de gestión de antibióticos son implementados como una herramienta para mitigar su impacto. Objetivo. Describir los cambios observados en los desenlaces clínicos después de la implementación de un programa de gestión de antibióticos en un hospital de IV nivel de atención. Materiales y métodos. Se llevó a cabo un estudio de cohorte única de pacientes hospitalizados por patologías infecciosas y tratados con antibióticos en una institución médica de alta complejidad. Inicialmente, se recolectaron las historias clínicas anteriores a la implementación del programa de gestión de antibióticos (2013 a 2015) y luego se compararon con los datos obtenidos después de la implementación del programa de gestión de antibióticos de 2018 a 2019. Se evaluaron los cambios en los desenlaces clínicos como mortalidad y estancia hospitalaria, entre otros. Resultados. Se analizaron las historias clínicas de 1.066 pacientes: 266 con historia previa a la implementación del programa y 800 con historia posterior a la implementación. El promedio de edad fue 59,2 años y 62 % de la población era masculina. Se encontraron diferencias estadísticamente significativas en mortalidad global (29 Vs. 15 %; p<0,001), mortalidad por causa infecciosa (25 % Vs. 9 %; p<0,001) y promedio de estancia hospitalaria (45 Vs.21 días; p<0,001), con tendencia a disminuir nuevas hospitalizaciones en 30 días por patología infecciosa (14 Vs.10 %; p=0,085). Conclusiones. El desarrollo del programa de gestión de antibióticos se asoció con a una disminución en la mortalidad global, la mortalidad por causa infecciosa y la estancia hospitalaria. Esto demuestra la importancia de desarrollar intervenciones dirigidas a mitigar el impacto de la prescripción inadecuada de antibióticos.

Cálculo de los Días de Terapia Antimicrobiana (DOT) en Cuidados Intensivos Pediátricos: una propuesta de metodología basada en el sistema informático de dispensación de medicamentos / Days of Antimicrobial Therapy (DOT) calculation in Pediatric Intensive Care: a methodology proposal based on the electronic records from the pharmacy dispensation system

INTRODUCCIÓN: El método recomendado para la medición de consumo de antimicrobianos (AMB) en pediatría es el cálculo del indicador Días de Terapia estandarizado por ocupación (DOT-std). Sin embargo, en hospitales que no cuentan con fichas electrónicas, obtener el numerador de los días de terapia (DOT) requiere revisión directa de las indicaciones del paciente, dificultando su aplicabilidad. OBJETIVOS: Validar el sistema de registros electrónicos de dispensación de medicamentos desde farmacia como fuente para el cálculo de DOT y DOT-std en la Unidad de Cuidados Intensivos Pediátrica (UCIP). MATERIALES Y MÉTODOS: Se revisaron las prescripciones de AMB desde la ficha clínica (método manual) y se compararon con los registros de dispensación de AMB a la UCIP (método informático) obtenidos del sistema de medicamentos de farmacia. Se evaluó la concordancia entre los DOT obtenidos mediante el Coeficiente de Correlación Intraclase. RESULTADOS: Los AMB más utilizados fueron vancomicina, meropenem y piperacilina/tazobactam. En 9 de 12 AMB se encontró concordancia significativa entre ambos métodos. CONCLUSIONES: Tras un proceso de validación local, los registros del sistema informático de dispensación de medicamentos desde farmacia podrían utilizarse para el cálculo de DOT en pediatría en hospitales que no cuenten con una ficha electrónica que permita su cálculo directo.

BACKGROUND: The recommended indicator for measuring antimicrobial (AMB) consumption in pediatric patients is the Days of Therapy indicator (DOT), which is then standardized by hospital occupancy rates (DOT-std). However, in hospitals that do not have electronic health records, obtaining the DOT requires a direct review of each pharmacological indication, which is not feasible in the long term. AIMS: To validate electronic records from the pharmacy dispensation system as a source for calculating DOT and estimating DOT-std in a Pediatric Intensive Care Unit (PICU). METHODS: AMB prescriptions at the PICU of a university hospital were directly reviewed (manual method) and compared with AMB dispensation records (computer method) obtained from the hospital pharmacy system. The Intraclass Correlation Coefficient was used to evaluate the agreement between the DOT obtained by both methods. RESULTS: The most used AMB were vancomycin, meropenem, and piperacillin/tazobactam. A significant agreement between the DOT obtained by using manual and computer methods was found in 9 of 12 evaluated AMB. CONCLUSIONS: After a local validation process, the electronic records of the pharmacy drug dispensation system could be considered a valid source for calculating DOT in PICUs in hospitals where electronic health records with prescription data are not yet available.

Antibiotic prescription patterns in paediatric wards of Rivers State university teaching hospital, southern Nigeria: a point prevalence survey

Antimicrobial resistance remains a threat to patient safety and healthcare outcomes and largely arises from inappropriate antimicrobial prescriptions. This study aimed to determine the pattern of antibiotic prescriptions in the Paediatrics department of Rivers State University Teaching Hospital, Port Harcourt.Method:A point prevalence survey was conducted in the Paediatric wards and Special Care Baby Unit (SCBU) on 13 November 2021. Records of all children admitted before or at 8:00a.m. on the day of the survey were descriptively analysed using the protocol and web-based management system of the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance, University of Antwerp.Results: The antibiotic prevalence in this study was 77.4%. The most common indication(s) for antibiotic use in SCBU was infection prophylaxis (81.3%) and in paediatric wards: Pneumonia, Ear Nose Throat and Soft tissue infections accounted for (23.1%) each. Third-generation cephalosporins and aminoglycosides were predominantly used in all wards and were empirical-based prescriptions. Regarding antibiotic quality indicators of prescriptions: In SCBU: 19 (90.5%) had indication(s) for antibiotics documented, 10 (46.7%) were guideline compliant, and 1 (4.8%) had documented review/stop date. In the paediatric medical and surgical wards, 17(85.0%) vs. 4(100%) had indication(s) for antibiotics documented, 6(30.0%) vs. 0(0%) were guideline compliant, and 1(5.0%) vs. 4(100.0%) had a review/ stop date.Conclusion:High prevalence of antibiotic use, suboptimal antibiotic quality indicators and absence of laboratory evidence for antibiotic prescriptions were observed in the paediatric units. There is a need to reorientate prescribers and institute strategic measures to improve antimicrobial stewardship

Evolución histórica de la Organización Mundial de la Salud y la resistencia a los antimicrobianos / Historical evolution of World Health Organization guidelines on antimicrobial resistance / Evolução histórica da Organização Mundial da Saúde e a resistência aos antimicrobianos

RESUMEN Objetivo. Mostrar la evolución de los lineamientos sobre políticas públicas en salud enfocadas en farmacorresistencia microbiana o resistencia a los antimicrobianos (RAM) que la Organización Mundial de la Salud (OMS) ha emitido desde 1948 hasta 2022. Además, se mencionan otras acciones gubernamentales relacionadas. Métodos. Se llevó a cabo una revisión detallada de los archivos de la Asamblea Mundial de la Salud y el Consejo Ejecutivo de la OMS. Se realizó un análisis textual de resoluciones sobre la RAM, que dan pauta al diseño de políticas y acciones gubernamentales para los Estados Miembros de la OMS. También se realizó una búsqueda sistemática en SCOPUS, Pubmed y literatura gris con categoría de análisis: políticas públicas en salud sobre la RAM. Resultados. La RAM se ha convertido en la mayor amenaza para la salud pública, y compromete el cumplimiento de los objetivos de desarrollo sostenible. Presentamos resoluciones de la OMS como evidencia de lineamientos para combatir la RAM. En consonancia, se menciona el enfoque "Una salud", estrategias, iniciativas, planes y programas relacionados. Se identificó una brecha en la investigación y el desarrollo de antimicrobianos nuevos, que requiere un análisis más profundo. Conclusiones. La OMS ha realizado esfuerzos para combatir la RAM. Esto ha generado un desarrollo integral de políticas públicas en salud, para que los Estados Miembros las apliquen según la soberanía de sus gobiernos.

ABSTRACT Objective. Show the evolution of guidelines on public health policies focused on antimicrobial resistance (AMR) issued by the World Health Organization (WHO) between 1948 and 2022. Other related government actions are also mentioned. Methods. A detailed review was conducted of World Health Assembly and WHO Executive Board archives. A textual analysis was conducted of AMR-related resolutions that guide the design of government policies and actions for WHO Member States. A systematic search was carried out in SCOPUS, PubMed, and grey literature under the category of public health policies on AMR. Results. AMR has become the greatest threat to public health, putting at risk the achievement of the Sustainable Development Goals. WHO resolutions are presented as evidence of guidelines to combat AMR. The One Health approach and related strategies, initiatives, plans, and programs are mentioned. A gap was identified in the research and development of new antimicrobials, requiring further analysis. Conclusions. WHO has made efforts to combat AMR. This has generated comprehensive development of public health policies to be implemented by the governments of Member States as they see fit.

RESUMO Objetivo. Apresentar a evolução das diretrizes sobre políticas públicas de saúde voltadas para a resistência microbiana a medicamentos ou resistência aos antimicrobianos (RAM) publicadas pela Organização Mundial da Saúde (OMS) de 1948 a 2022. Além disso, mencionam-se outras ações governamentais relacionadas. Métodos. Procedeu-se a uma revisão detalhada dos arquivos da Assembleia Mundial da Saúde e do Conselho Executivo da OMS. Realizou-se uma análise textual das resoluções sobre RAM, que orientam a formulação de políticas e ações governamentais para os Estados Membros da OMS. Fez-se também uma busca sistemática nas plataformas SCOPUS e Pubmed e na literatura cinzenta, com a categoria de análise "políticas públicas de saúde sobre RAM". Resultados. A RAM tornou-se a maior ameaça à saúde pública e prejudica o cumprimento dos Objetivos de Desenvolvimento Sustentável. Apresentamos as resoluções da OMS como evidência de diretrizes para combater a RAM. Nesses termos, mencionam-se a abordagem "Saúde Única" e estratégias, iniciativas, planos e programas relacionados. Identificou-se uma lacuna na pesquisa e no desenvolvimento de novos antimicrobianos, o que requer uma análise mais aprofundada. Conclusões. A OMS envidou esforços para combater a RAM, o que levou ao desenvolvimento integral de políticas públicas de saúde a serem aplicadas pelos Estados Membros, em conformidade com a soberania de seus governos.

Transição de via de linezolida endovenosa para via oral: uma análise de custo-minimização / Switching from intravenous to oral linezolid therapy: a cost-minimization analysis

Objetivo: Comparar custos da terapia endovenosa exclusiva com linezolida com os custos da terapia iniciada por via endovenosa com transição para via oral após 72 horas, como estratégia de intervenção em programas de gestão de antimicrobianos. Métodos: Avaliação econômica de custo-minimização comparando custos diretos da terapia endovenosa exclusiva com linezolida com a terapia endovenosa seguida de transição para via oral em cenário simulado, sob a perspectiva do Sistema Único de Saúde (SUS), com árvore de decisão como modelo para tomada de decisão. Resultados: A alternativa englobando a transição de via mostrou-se a mais econômica em todos os cenários analisados. Para 28 dias de tratamento com linezolida, houve redução de 22% nos custos, considerando o paciente internado. Ao considerar alta após o sexto dia de tratamento, a redução de custos variou de 26%, com financiamento pelo SUS do restante do tratamento, a 84%, com financiamento do tratamento pós-alta pelo paciente. Conclusão: Conclui-se que a transição de via de linezolida é uma importante estratégia nos programas de gerenciamento de antimicrobianos, capaz de gerar economia significativa para a instituição. As avaliações econômicas de custo-minimização, nesse contexto, são uma importante ferramenta para demonstrar o aspecto econômico com potencial para sensibilizar gestores e tomadores de decisão.

Objective: To compare the direct costs of linezolid intravenous therapy with the costs of intravenous therapy switching to oral therapy after 72 hours as an intervention strategy in antimicrobial stewardship programs. Methods: Economic evaluation cost-minimization comparing direct costs of exclusive linezolid intravenous therapy with intravenous therapy for 72 hours and after switching to oral therapy in a simulated scenario, from the perspective of the National Health Service, with a decision tree as a decision modeling. Results: The alternative encompassing the therapy transition proved to be the most economical in all analyzed scenarios. For 28 days of treatment with linezolid, there was a 22% reduction in costs, considering the hospitalized patient. When considering discharge after the sixth day of treatment, the cost reduction ranged from 26%, with funding from the National Health Service for the rest of the treatment, to 84%, with funding for the post-discharge treatment by the patient. Conclusion: It was concluded that the linezolid therapy transition is an important strategy in antimicrobial management programs, capable of generating significant savings for the institution. In this context, economic cost-minimization assessments are an important tool to demonstrate the economic aspect with the potential to raise awareness among managers and decision-makers.

Effects of in feed removal of antimicrobials in comparison to other prophylactic alternatives in growing and finishing pigs / [Efeitos na remoção de antimicrobianos na ração em comparação a alternativas profiláticas em suínos nas fases de crescimento e de terminação]

The utilization of antimicrobials in animal production, causes selection of resistant bacteria. The objective of this study was to compare the utilization of alternatives in association with preventive antibiotic therapy in swine feed during the growing and finishing phases. 1,045 animals were used from 60 to 190 days of age and were subjected to six treatments with 16 repetitions as follows: 1) antibiotic free; 2) antibiotics; 3) prebiotic; 4) probiotic; 5) essential oils; and 6) organic acid. Animals were weighted, and clinical history was recorded including mortality and diarrhea. At the abattoir, pneumonia index and gastric ulcers were investigated. The cost for each treatment was discussed. No difference between treatments were observed (P>0.05) regarding feed conversion rate (2.64±0.03), overall average weight gain (107.06±0.9kg), average daily weight gain (856.49±7.7g) and carcass weight (92.4±0.7kg). The application injectable drugs in animals presenting clinical symptoms, represented US$ 0.56/intervention, without difference between the treatments (P>0.05). Furthermore, independently of the treatment, high frequency of pneumonia was observed (>0.90). No difference for the degree of gastric ulcer nor feces consistency were observed (P>0.05). The utilization of antibiotic therapy and alternatives to antibiotics in feed did not produce benefits to the production indices and sanitary performances of the animals.(AU)

A utilização de antimicrobianos na produção animal provoca seleção de bactérias resistentes. O objetivo do estudo foi comparar a utilização de alternativas associadas à antibioticoterapia preventiva na alimentação de suínos nas fases de recria e de terminação. Foram utilizados 1.045 animais de 60 a 190 dias de idade, submetidos a seis tratamentos com 16 repetições, como segue: 1) sem antibióticos; 2) com antibióticos; 3) prebióticos; 4) probióticos; 5) óleos essenciais; e 6) ácidos orgânicos. Os animais foram pesados, e a história clínica foi registrada, incluindo mortalidade e diarreia. No abatedouro, foram investigados índices de pneumonia e úlceras gástricas. O custo de cada tratamento foi discutido. Não houve diferença entre os tratamentos (P>0,05) em relação à taxa de conversão alimentar (2,64 ± 0,03), ao ganho de peso médio geral (107,06 ± 0,9kg), ao ganho de peso médio diário (856,49 ± 7,7g) e ao peso de carcaça (92,4 ± 0,7kg). A aplicação de medicamentos injetáveis em animais com quadro clínico representou US$ 0,56/intervenção, sem diferença entre os tratamentos (P>0,05). Além disso, independentemente do tratamento, foi observada alta frequência de pneumonia (>0,90). Não foi observada diferença para o grau de úlcera gástrica nem na consistência das fezes (P>0,05). A utilização de antibioticoterapia e de alternativas aos antibióticos na ração não trouxe benefícios aos desempenhos zootécnico e sanitário dos animais.(AU)

Contribución del químico farmacéutico en los programas de gerenciamiento de antimicrobianos: estudio de cohortes ambispectivo / Pharmacist´s contribution on antimicrobial stewardship program: ambispective cohort study

INTRODUCCIÓN: El programa de gerenciamiento de antimicrobianos (PGAn) promueve el uso racional de los antimicrobianos, garantizando que cada paciente reciba el fármaco correcto, por el tiempo correcto, por la vía y a la dosis correcta. OBJETIVO: Establecer la asociación de los resultados de un PGAn liderado por un químico farmacéutico, en términos de consumo de antimicrobianos, duración del tratamiento y costos, en una institución prestadora de salud de alta complejidad. MATERIALES Y MÉTODO: Estudio de cohortes ambispectivo. En la cohorte expuesta, (entorno de un PGAn), un químico farmacéutico con entrenamiento en enfermedades infecciosas evaluó e intervino la indicación, dosis, duración del tratamiento y espectro bacteriano del antimicrobiano. La cohorte no expuesta fue una población retrospectiva similar (pareada) a la cohorte expuesta, pero sin la evaluación de su terapia antimicrobiana. RESULTADOS: Se identificaron 258 pacientes en la cohorte expuesta y 247 en la cohorte no expuesta al PGAn. Se observó una disminución en el consumo de antimicrobianos (119.831 vs 137.678 DDD/100 pacientes-día, p < 0,001) y una disminución de 34,1% en los costos asociados a la antibioticoterapia de la cohorte expuesta, en comparación con la cohorte no expuesta al PGAn. CONCLUSIÓN: El PGAn liderado por un químico farmacéutico se asocia a mejores resultados en términos de consumo y menores costos de la terapia antimicrobiana.

BACKGROUND: Antimicrobial stewardship program (AMSP) promotes the rational use of the antimicrobial, ensuring that each patient receives the correct antibiotic, by the correct time and at the correct dose. AIM: To establish the association of the results of an AMSP led by a pharmaceutical chemist, in terms of antibiotic consumption, duration of treatment and costs in a tertiary healthcare setting. METHOD: Ambispective cohort study. In the exposed cohort, in the environment of a AMSP, a pharmacist with training in infectious diseases evaluated and intervened the indication, dosage, duration of treatment and bacterial spectrum of the antimicrobial. The no-exposed cohort corresponded to a retrospective population that was similar (paired) to the exposed cohort, but that did not receive an evaluation of its antimicrobial therapy. RESULT: 258 patients were identified in the exposed cohort and 247 in the cohort not exposed to the AMSP. Decrease in the consumption of antibiotics was observed (119,831 vs 137,678 DDD/100 patients-day, p < 0.001) and a decrease in 34.1% of the costs associated with antibiotic therapy of the exposed cohort, in comparison with the cohort not exposed to the AMSP. CONCLUSION: AMSP led by a pharmacist have better outcomes in terms of consumption and lower costs associated with antibiotic therapy.

Antimicrobial stewardship in the outpatient parenteral antimicrobial therapy (OPAT) setting: the impact of prescription assessment by an infectious diseases specialist

ABSTRACT Objective: In recent years, the use of outpatient parenteral antimicrobial therapy (OPAT) has increased, resulting in the need to ensure its rational and adequate utilization. This article describes the implementation of an antimicrobial stewardship program in the OPAT setting by a Health Maintenance Organization (HMO) and its results. Method: An infectious disease (ID) physician made routine assessments of all home care parenteral antimicrobial requests from February to December 2019. Information on diagnosis, renal function, weight, previous antimicrobials, and microbiology were gathered during remote evaluations. Prescription changes recommended by the ID specialist were not mandatory, but implemented by the primary provider as accepted. Antibiotic consumption data was analyzed from January 2018 to December 2019. An active screening was conducted for treatment failures: two or more treatment course requirements, or death within 15 days of the evaluation were reexamined. Results: A total of 506 antimicrobial requests were assessed. The most frequent diagnoses were urinary tract infection, pneumonia, and orthopedic surgical site infection. Six percent of evaluations were not completed due to insufficient information and 12% were requests by the primary physician for initial antimicrobial guidance. Of the 416 completed prescriptions evaluations, 58% had suggested changes, including different antimicrobials (40%), treatment duration (25%), and route of administration (23%). There was an increase in use of teicoplanin and meropenem, and a decrease in ceftriaxone, ertapenem, cefepime, amikacin and daptomycin use. The HMO's overall parenteral antimicrobial outpatient consumption, which had shown an upward trend over the previous year, decreased after program initiation. No major adverse results were detected in patients' clinical outcomes; two treatment failures were detected and promptly corrected; no deaths attributed to antibiotic changes were detected. Conclusion: Outpatient antimicrobial stewardship, through remote assessment by an ID specialist, was effective and safe in the OPAT setting.

Current status of antimicrobial stewardship programs in São Paulo Hospitals

OBJECTIVES: Antimicrobial stewardship programs (ASPs) comprise coordinated interventions designed to improve antimicrobial use. Understanding the current structure of ASP hospitals will support interventions for the improvement of these programs. This study aimed to describe the status of ASPs in hospitals in São Paulo, Brazil. METHODS: A cross-sectional survey was conducted on the ASPs of hospitals in the state of São Paulo from March to July 2018. Through interviews by telephone or e-mail, we queried which components of the Infectious Diseases Society of America/Society for Healthcare Epidemiology of America and Centers for Disease Control and Prevention guidelines were implemented. RESULTS: The response rate was 30% (28/93 hospitals), and 26 hospitals (85%) reported having a formal ASP. The most frequently implemented strategies were antimicrobial surgical prophylaxis guidelines (100%), empiric sepsis guidelines (93%), and the presence of ASP team members during bedside rounds (96%). The least commonly implemented strategies included prior authorization for all antimicrobials (11%), pharmacokinetic monitoring, and an adjustment program for patients on IV aminoglycosides (3%). Regarding the metrics of the ASP, the most common indicator was the rate of antimicrobial resistance (77%). Eighteen hospitals evaluated antimicrobial consumption using defined daily dose, and only 29% evaluated the days of therapy; 61% of hospitals reported their results to the hospital administration and 39% to the prescribers. CONCLUSIONS: Most hospitals have a formal and active ASP, but with timely actions. We observed inconsistencies between what program leaders understand as the main objective of ASP and the metrics used to evaluate it. Part of the effort for the next few years should be to improve program evaluation metrics and to provide feedback to physicians and hospital leadership.

Estratégias para o uso seguro de antimicrobianos pela enfermagem no ambiente hospitalar: revisão integrativa / Strategies for the safe use of antimicrobials by nursing in the hospital environment: an integrative review / Estrategias para el uso seguro de antimicrobianos por parte de la enfermería en el ámbito hospitalario: revisión integradora

OBJETIVO: identificar as estratégias para o uso seguro de antimicrobianos adotadas pela enfermagem no ambiente hospitalar. MÉTODO: revisão integrativa, realizada no período de junho a julho de 2020, nas bases de dados da LILACS, MEDLINE, CINAHL e EMBASE. Selecionaram-se artigos de 2015 a junho de 2020. Para a análise dos níveis de evidência, adotou-se o método Grading of Recomendations Assessment, Developing and Evaluation. RESULTADOS: encontraram-se oito artigos, distribuídos em estratégias gerenciais e assistenciais de enfermagem, relacionadas ao uso seguro de antimicrobianos. DISCUSSÃO: dentre as principais estratégias gerenciais, destacam-se o papel de educador do enfermeiro e a formação de comitês de monitoramento multidisciplinar; e dentre as assistenciais, as especificidades técnicas da administração de antimicrobianos. CONCLUSÃO: as principais estratégias práticas de Enfermagem encontradas foram educação profissional no uso racional e monitoramento multidisciplinar na resistência antimicrobiana no ambiente hospitalar. Acredita-se que a identificação dessas estratégias contribua para o desenvolvimento de melhores práticas na segurança medicamentosa.

OBJECTIVE: to identify the strategies for the safe use of antimicrobials adopted by Nursing in the hospital environment. METHOD: an integrative review, carried out from June to July 2020, on the LILACS, MEDLINE, CINAHL, and EMBASE databases. Articles from 2015 to June 2020 were selected. For the analysis of the evidence levels, the Grading of Recommendations Assessment, Development and Evaluation was adopted. RESULTS: eight articles were found, distributed in Nursing management and care strategies, related to the safe use of antimicrobials. DISCUSSION: among the main managerial strategies, the role of the educator and the setting up of multidisciplinary monitoring committees stand out; and, among the care strategies, the technical specificities of antimicrobial stewardship. CONCLUSION: the main Nursing practical strategies found were professional education in the rational use and multidisciplinary monitoring of antimicrobial resistance in the hospital environment. It is believed that the identification of these strategies will contribute to the development of better practices in drug safety.

OBJETIVO: identificar las estrategias para el uso seguro de antimicrobianos adoptadas por la enfermería en el ámbito hospitalario. MÉTODO: revisión integradora, realizada de junio a julio de 2020, de las bases de datos de LILACS, MEDLINE, CINAHL y EMBASE. Se seleccionaron artículos de 2015 a junio de 2020. Para el análisis de niveles de evidencia se adoptó el método Grading of Recomendations Assessment, Developing and Evaluation. RESULTADOS: se encontraron ocho artículos, distribuidos en estrategias gerenciales y asistenciales de enfermería, relacionados con el uso seguro de antimicrobianos. DISCUSIÓN: entre las principales estrategias gerenciales se destaca el rol de la enfermera educadora y la conformación de comités de seguimiento multidisciplinarios; y entre las asistenciales, las especificidades técnicas de la administración de antimicrobianos. CONCLUSIÓN: las principales estrategias prácticas de enfermería encontradas fueron la formación profesional en el uso racional y el seguimiento multidisciplinario de la resistencia a los antimicrobianos en el ámbito hospitalario. Se cree que la identificación de estas estrategias contribuye al desarrollo de mejores prácticas en seguridad de medicamentos.