Pseudomonas aeruginosa in the ICU: prevalence, resistance profile, and antimicrobial consumption

Abstract INTRODUCTION: Pseudomonas aeruginosa is one of the main pathogens causing infection in intensive care units (ICUs) and usually presents antimicrobial resistance. METHODS: Data were obtained from ICUs between 2010 and 2013. RESULTS: P. aeruginosa had a prevalence of 14.5% of which 48.7% were multidrug resistant. We observed increasing resistance to carbapenems and polymyxin B and growing consumption of aminoglycosides, meropenem, ceftazidime, and polymyxin B. The regression impact between resistance and consumption was significant with respect to amikacin, imipenem, meropenem, and polymyxin B. CONCLUSIONS: Monitoring antimicrobial consumption and resistant microorganisms should be reinforced to combat antimicrobial- and multi-drug resistance.

Pseudomonas aeruginosa in the ICU: prevalence, resistance profile, and antimicrobial consumption.

INTRODUCTION: Pseudomonas aeruginosa is one of the main pathogens causing infection in intensive care units (ICUs) and usually presents antimicrobial resistance. METHODS: Data were obtained from ICUs between 2010 and 2013. RESULTS: P. aeruginosa had a prevalence of 14.5% of which 48.7% were multidrug resistant. We observed increasing resistance to carbapenems and polymyxin B and growing consumption of aminoglycosides, meropenem, ceftazidime, and polymyxin B. The regression impact between resistance and consumption was significant with respect to amikacin, imipenem, meropenem, and polymyxin B. CONCLUSIONS: Monitoring antimicrobial consumption and resistant microorganisms should be reinforced to combat antimicrobial- and multi-drug resistance.

Health professionals' perception of patient safety culture in a university hospital in São Paulo: A cross-sectional study applying the Hospital Survey on Patient Safety Culture.

BACKGROUND: Patient safety culture is part of the organizational profile of healthcare institutions and is associated with better quality of care. OBJECTIVE: To assess patient safety culture in a university hospital. DESIGN AND SETTING: Hospital-based cross-sectional study conducted in a public university hospital in São Paulo, Brazil, between September and December 2015. METHODS: We randomly selected 68 sectors of the hospital, to include up to 5 employees from each sector, regardless of length of experience. We used the validated Brazilian version of the Hospital Survey on Patient Safety Culture (HSOPS) via an electronic interface. We calculated the percentage of positive responses for each dimension of the HSOPS and explored the differences in age, experience, occupation and educational level of respondents using the chi-square test. RESULTS: Out of 324 invited respondents, 314 (97%) accepted the invitation and were surveyed. The sample presented predominance of women (72%), nursing staff (45%) and employees with less than six years' experience at the hospital (60%). Nine out of the 12 dimensions showed percentages of positive responses below 50%. The worst results related to "nonpunitive response to errors" (16%). A better safety culture was observed among more experienced staff, nurses and employees with a lower educational level. In the previous year, no events were reported by 65% of the participants. CONCLUSIONS: The patient safety culture presented weaknesses and most of professionals had not reported any event in the previous year. A policy for improvement and cyclical assessment is needed to ensure safe care.

Health professionals' perception of patient safety culture in a university hospital in São Paulo: A cross-sectional study applying the Hospital Survey on Patient Safety Culture

ABSTRACT BACKGROUND: Patient safety culture is part of the organizational profile of healthcare institutions and is associated with better quality of care. OBJECTIVE: To assess patient safety culture in a university hospital. DESIGN AND SETTING: Hospital-based cross-sectional study conducted in a public university hospital in São Paulo, Brazil, between September and December 2015. METHODS: We randomly selected 68 sectors of the hospital, to include up to 5 employees from each sector, regardless of length of experience. We used the validated Brazilian version of the Hospital Survey on Patient Safety Culture (HSOPS) via an electronic interface. We calculated the percentage of positive responses for each dimension of the HSOPS and explored the differences in age, experience, occupation and educational level of respondents using the chi-square test. RESULTS: Out of 324 invited respondents, 314 (97%) accepted the invitation and were surveyed. The sample presented predominance of women (72%), nursing staff (45%) and employees with less than six years' experience at the hospital (60%). Nine out of the 12 dimensions showed percentages of positive responses below 50%. The worst results related to "nonpunitive response to errors" (16%). A better safety culture was observed among more experienced staff, nurses and employees with a lower educational level. In the previous year, no events were reported by 65% of the participants. CONCLUSIONS: The patient safety culture presented weaknesses and most of professionals had not reported any event in the previous year. A policy for improvement and cyclical assessment is needed to ensure safe care.

Muscle adverse events among users of simvastatin in primary health care: collaborative drug therapy management / Eventos adversos musculares entre usuários de sinvastatina na atenção primária em saúde: manejo colaborativo de terapia medicamentosa

Collaborative drug therapy management in primary health care involves communication among the physician, pharmacist and user of simvastatin and can result in safer results regarding patient wellbeing. The aim of the study was to investigate muscle adverse events and risk factors related to simvastatin. For patients who developed muscle adverse events, collaborative drug therapy management was performed in an attempt to resolve the symptoms. A non-randomized case study was conducted at the single basic health unit in the city of Peabiru, Parana, Brazil, for a period of one year. Patients were interviewed using a structured form. To confirm muscle adverse events, the patient was referred to a physician and submitted to the suspension and return to treatment. Thyroid-stimulating hormone, creatine kinase and alanine aminotransferase exams were performed. A sample of 148 users of simvastatin was selected. Eleven patients had some type of simvastatinassociated muscle adverse event (myopathy), among whom seven had muscle symptoms (myalgia) and four had elevated creatine kinase, but were asymptomatic (asymptomatic myopathy). Collaborative drug therapy management focused on simvastatin for five patients with myalgia led to improvements in the quality of life of two patients.

O manejo colaborativo de tratamento medicamentoso em atenção primária envolve a comunicação entre o médico, farmacêutico e o usuário de sinvastatina e pode levar a resultados mais seguros, favorecendo o bem-estar do paciente. O objetivo do estudo foi investigar eventos adversos musculares e fatores de risco para tais eventos, relacionados à sinvastatina. Para os pacientes que desenvolveram eventos adversos musculares, o manejo colaborativo foi realizada de forma a resolver os sintomas. Um estudo de caso não randomizado foi realizado na única unidade básica de saúde na cidade de Peabiru, Paraná, Brasil, por um período de um ano. Os pacientes foram entrevistados por meio de um formulário estruturado. Para confirmar os eventos adversos musculares, o paciente era encaminhado ao médico, sendo submetido à suspensão e retorno da sinvastatina. Foram realizadas dosagens do hormônio tireoestimulante, creatina quinase e alanina aminotransferase. Uma amostra de 148 usuários de simvastatina foi selecionada. Do grupo estudado, 11 pacientes tiveram algum tipo de evento adverso muscular (miopatia) associada à sinvastatina, entre os quais sete tiveram sintomas musculares (mialgia) e quatro apresentaram elevação da creatina quinase, mas eram assintomáticos (miopatia assintomática). O manejo colaborativo de terapia medicamentosa focada na sinvastatina para cinco pacientes com mialgia levou a melhoria na qualidade de vida de dois pacientes

Prescrição de antibióticos a crianças atendidas no inverno em Unidade de Saúde de município paulista / Prescription of antibiotics to children in winter at a basic health unit in the state of São Paulo, Brazil

Estudos de utilização de medicamentos podem contribuir para a antibioticoterapia racional, por revelarem perfis de utilização, possíveis distorções e necessidades de intervenção. O objetivo deste trabalho foi avaliar as características das prescrições médicas de antibióticos na terapêutica de crianças de 0 a 5 anos de idade de Unidade de Saúde de Santa Bárbara d’Oeste-SP, no inverno. O estudo de delineamento transversal foi conduzido entre julho e agosto de 2008. Das 262 prescrições emitidas no período, 173 (66%) apresentaram pelo menos um antibiótico. Entre estas, identificou-se a média de 2,9 medicamentos prescritos por receita, 93% sob denominação genérica e 96% constantes na Relação Municipal de Medicamentos Essenciais. A amidalite foi a causa mais frequente de indicação de antibióticos, seguida de otite e bronquite. O fármaco mais prescrito foi a amoxicilina, exceto para doenças de pele, feridas auriculares e gastroenterocolite. Em 25% das prescrições houve associação de antibióticos, sendo 81% amoxicilina associada à penicilina benzatina potássica. A amoxicilina foi prescrita em doses diárias acima do recomendado pelos Guideliness em 63,5% das prescrições e frequentemente em conjunto com o ambroxol. A alta prevalência do emprego conjunto de fármacos de mesma classe terapêutica e o elevado número de vezes em que houve sobredose nas prescrições pode ser prejudicial à saúde das crianças.

Studies on medication use can contribute to rational antibiotic therapy, revealing use patterns, possible distortions and the need for interventions. The aim of the present study was to evaluate the use of antibiotic therapy for children aged 0 to five years at a basic health unit in the city of Santa Barbara d’Oeste (state of São Paulo, Brazil) based on prescriptions made in winter. A cross-sectional study was conducted between July and August 2008. From a total of 262 prescriptions issued in the period, 173 (66%) had at least one prescription of antibiotics. The mean number of drugs prescribed per prescription was 2.9. A total of 93% of the drugs were prescribed under the generic denomination and 96% were included on the Municipal Essential Drugs List. Tonsillitis was the most frequent indication for antibiotics, followed by otitis and bronchitis. The most prescribed drug was amoxicillin, except for skin diseases, ear injuries and gastroenterocolitis. Antibiotics were prescribed in association in 25% of the prescriptions and amoxicillin was associated with potassium benzathine penicillin in 81% of such cases. Amoxicillin was prescribed in excessive doses in 63.5% of prescriptions and often together with the ambroxol. The high frequency of joint drug prescriptions from the same therapeutic class and the large number of times in which an excessive dose was prescribed constitute a risk to child health.

Antiretroviral treatment adherence in childhood and adolescence: multidisciplinary team as an associated factor in Brazil.

Our aim was to analyze factors associated with non-adherence to antiretroviral (ARV) treatment among children and adolescents. A cross-sectional study was carried out involving non-institutionalized children and adolescents between 2 and 20 years of age, addressing non-adherence to ARV treatment, which was defined as taking ≤89% of the medications on the day of the interview and the three previous days. The investigation into the association between non-compliance and the variables of interest was performed using unconditional logistic regression. The independent factors associated with non-adherence were forgetfulness (OR = 3.22; 95%CI = 1.75-5.92), difficulties coping with treatment (OR = 2.65; 95%CI = 1.03-6.79), and living with grandparents (OR = 2.28; 95%CI = 1.08-4.83), whereas a protective effect was found with participation in multidisciplinary activities (OR = 0.49; 95%CI = 0.25-0.96), i.e., this factor indicates that the exposure to the variable is beneficial, promoting adherence. We concluded that forgetting to take the medications and reporting having difficulty coping with ARV treatment are potentially modifiable factors through educational and programmatic actions. Residing with one's grandparents may strongly impact adherence to ARV treatment, indicating the need for the systematic support of these family members. Participation in multidisciplinary activities should be stimulated at health-care services.

Potential drug-drug interactions in prescriptions to patients over 45 years of age in primary care, southern Brazil.

BACKGROUND: Few cross-sectional studies involving adults and elderly patients with major DDIs have been conducted in the primary care setting. The study aimed to investigate the prevalence of potential drug-drug interactions (DDIs) in patients treated in primary care. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional study involving patients aged 45 years or older was conducted at 25 Basic Health Units in the city of Maringá (southern Brazil) from May to December 2010. The data were collected from prescriptions at the pharmacy of the health unit at the time of the delivery of medication to the patient. After delivery, the researcher checked the electronic medical records of the patient. A total of 827 patients were investigated (mean age: 64.1; mean number of medications: 4.4). DDIs were identified in the Micromedex® database. The prevalence of potential DDIs and major DDIs was 63.0% and 12.1%, respectively. In both the univariate and multivariate analyses, the number of drugs prescribed was significantly associated with potential DDIs, with an increasing risk from three to five drugs (OR = 4.74; 95% CI: 2.90-7.73) to six or more drugs (OR = 23.03; 95% CI: 10.42-50.91). Forty drugs accounted for 122 pairs of major DDIs, the most frequent of which involved simvastatin (23.8%), captopril/enalapril (16.4%) and fluoxetine (16.4%). CONCLUSIONS/SIGNIFICANCE: This is the first large-scale study on primary care carried out in Latin America. Based on the findings, the estimated prevalence of potential DDIs was high, whereas clinically significant DDIs occurred in a smaller proportion. Exposing patients to a greater number of prescription drugs, especially three or more, proved to be a significant predictor of DDIs. Prescribers should be more aware of potential DDIs. Future studies should assess potential DDIs in primary care over a longer period of time.

Adesão ao tratamento anti-retroviral na infância e adolescência / Adherence to anti-retroviral treatment during childhood and adolescence

A não adesão ao tratamento anti-retroviral implica no risco de falha terapêutica e queda da qualidade de vida. Objetivos: Estimar os níveis de adesão aos medicamentos anti-retrovirais (ARVs) na prática clínica e analisar fatores associados. Avaliar a concordância entre adesão auto-referida e as concentrações plasmáticas dos medicamentos ARV, numa sub-amostra. Métodos: Estudo de corte transversal, incluindo crianças e adolescentes não institucionalizadas, com idade entre um a 20 anos, atendidas no Instituto de Infectologia Emílio Ribas/São Paulo.Utilizou-se questionário estruturado e, para um sub-grupo, coletou-se sangue para dosagens plasmáticas de Efavirenz. Resultados: Dos 262 participantes do estudo, 40,1 por cento não apresentaram adequada adesão aos ARVs, tomando até 89 por cento das doses prescritas para o dia da entrevista e três anteriores. Os fatores que se mostraram associados à não adesão após o ajuste no modelo de regressão logística múltipla foram: ter dificuldades em usar ARVs por esquecer de tomar, residir com os avós, referir dificuldades em lidar com o tratamento ARV e como fator protetor, participar de atividades multiprofissionais. Foi demonstrada diferença significativa entre as médias das concentrações plasmáticas de Efavirenz para o grupo com e sem adesão adequada. Tendo como referência a mensuração da concentração plasmática do Efavirenz, o método da adesão auto-referida apresentou baixa sensibilidade e alta especificidade, sendo moderada a proporção de concordância entre dois métodos (Kappa: 0,41). Conclusões: A dosagem das concentrações plasmáticas poderia ser incorporada na rotina de atendimento para acompanhamento da adesão ao Efevirenz. Considerando a baixa adesão aos medicamentos ARVs, torna-se importante estabelecer estratégias de acompanhamento envolvendo os fatores modificáveis associados à não adesão.

Acompanhamento farmacoterapêutico de crianças sob prescrição de antimicrobianos: um estudo em farmácia comunitária / Pharmacotherapeutic follow-up of children under antimicrobial prescription: a community pharmacy study

Atualmente, os antibióticos estão entre os medicamentos prescritos com maior freqüência, tanto em ambulatórios quanto em hospitais. As infecções respiratórias agudas são importante causa para atenção médica em atendimento primário à saúde nos países em desenvolvimento, para as quais há necessidade de se garantir uma apropriada adesão, não somente para evitar falhas terapêuticas, mas também para diminuir os riscos de complicações. O estudo teve como objetivo identificar variáveis sociais e fármaco-epidemiológicas, por meio do acompanhamento de cuidadores de crianças responsáveis pela administração de antimicrobianos prescritos. O estudo foi prospectivo e descritivo, desenvolvido em uma farmácia comunitária da cidade de Ibiporã-PR, de maio a julho de 2003. A amostra foi de 85 crianças de zero a 15 anos de idade.A maioria dos cuidadores possuía no mínimo oito anos de escolaridade e a administração do antibiótico era realizada pela mãe/pai. Observou-se que para a amoxicilina, administrada entre o 1º e 3º dia, a categoria "nenhuma queixa" foi referidapor 83% dos cuidadores, enquanto para a cefalexina, por 70%; entre o 4º e 7º dia, para a amoxicilina foi de 81% e de 86% para a cefalexina. A ocorrência de reações adversas a medicamentos (RAM) foi de 30% para a cefalexina e de 19% para a amoxicilina. No 5o dia 44% das crianças haviam interrompido o tratamento com amoxicilina e 14% com cefalexina. Estes achados reforçam a necessidade de acompanhamento farmacoterapêutico sistematizado

Currently, antibiotics are among the most often prescribed medication, as in ambulatories as in hospitals. The acute respiratory infections are an important issue for the medical care regarding fi rst health care in developing countries where there is a need of guaranteeing appropriate adherence, not only to avoid therapeutic fl aw, but also to decrease the risk of complications. The goal of the research was to identify social and pharmacoepidemiological variables, and to accompany children's caretakers responsible for the administration of antimicrobial prescription. The study was prospective and descriptive, and developed in a community pharmacy in Ibiporã (Paraná State, Brazil) from May to July 2003. The sample consisted of 85 children (0 to 15 years old). Most caretakers had at least eight years of schooling and the antibiotics were administered by the mother/father. For Amoxicilin, administered between the 1st and 3rd, day 83% of the caretakers mentioned the "no complaints" category, as 70% for Cephalexin.When administered between the 4th and 7th day, the results were 81 and 86%, respectively. The occurrence of adverse drug reactions (ADR) was 30% for cephalexin (1st and 3rd day) and 19% for Amoxicilin (4th and 7th day). By the fi fth day, 44% of the children had interrupted the Amoxicilin treatment and 14% the Cephalexin therapy. These findings reinforce the need for systematized pharmacotherapeutic follow-up

[A literature review on pharmacists' interventions in the use of medication by elderly patients]. / Revisão dos estudos de intervenção do farmacêutico no uso de medicamentos por pacientes idosos.

The total proportional geriatric population in Brazil is projected to increase from 9.05% in 1999 to approximately 13% in 2020. Non-communicable diseases are common in this age group, and medication is used frequently. Inadequate prescription and improper use of drugs can produce undesirable outcomes, leading to avoidable hospitalization and increasing health care costs. The objective of this paper was to conduct a literature review of pharmacists' interventions and their influence on use of medication by elderly patients, based on five databases from 1970 to 1999. The sample consisted of 76 studies, of which 15 were analyzed and discussed. Research on this subject is scarce, and limited to developed countries. In general, the interventions presented favorable outcomes. Most actions were limited to counseling patients and their physicians, and there was a lack of interventions to adjust the medication to the user.

Revisäo dos estudos de intervençäo do farmacêutico no uso de medicamentos por pacientes idosos / A literature review on pharmacists' interventions in the use of medication by elderly patients

No Brasil, os idosos representavam 9,05 por cento em 1999 e, em 2020, poderäo totalizar 13 por cento da populaçäo. Nessa faixa etária as doenças crônicas e degenerativas säo comuns e freqüentemente se utiliza muitos medicamentos. A prescriçäo e o uso inadequado dos mesmos podem levar a resultados indesejados, acarretando internaçöes hospitalares evitáveis e elevando os custos do sistema de saúde. O objetivo deste trabalho foi conhecer os estudos de intervençäo do farmacêutico e sua influência no uso de medicamentos pelo paciente idoso, listados em cinco bases de dados, no período entre 1970 e 1999. Foram localizados 76 artigos, resultando em 15 trabalhos para análise e discussäo. Os estudos sobre o tema säo escassos e limitados aos países de economia avançada. De uma forma geral, as intervençöes apresentaram resultado positivo. A maioria das intervençöes limitou-se ao aconselhamento ao usuário e/ou ao prescritor, notando-se falta de açöes que levem à adequaçäo do medicamento ao usuário

Estudo da utilizaçäo de antimicrobianos em infecçöes respiratórias agudas em crianças atendidas nas unidades de saúde de Maringá-PR: adesäo e nível de informaçäo na perspectiva do paciente / Antibiotics use in children with acute respiratory infections in the units of health of Maringa - Parana, Brazil: the level of information, adhesion to prescriptions at pacient's perspective

Caracteriza a utilizaçäo de antimicrobianos em crianças portadoras destas condiçöes, avaliando o nível de informaçäo, adesäo às prescriçöes e fatores relacionados. Crianças de 0-14 atendidas nas unidades de saúde de Maringá -PR, foram identificadas consecutivamente na pós-consulta. Aquelas com IRA e prescriçäo de antimicrobianos foram visitados em seus domicílios para entrevista com os responsáveis. o nível de informaçäo sobre antimicrobianos foi definido segundo categorias informaçöes gerais e atuais. o estudo da adesäo ao tratamento de uso. As IRAs foram a causa do atendimento em 55,6 por cento dos casos e destes 53,2 por cento receberam antimicrobianos. A amoxicilina foi prescrita em 79,25 por cento dos casos em doses de 12 até 78mg/kg/dia. Menos de 30 por cento dos entrevistados atingiu bom nível de informaçöes nas categoria informaçöes gerais ou atuais. A adesäo ao tratamento, segundo o teste de Moriski-Green ocorreu em 25,0 por cento da amostra. A determinaçäo da taxa de adesäo pelo número de doses administradas e quantidade do medicamento restante nas embalagens, demonstrou que 45,8 por cento foram aderentes ao tratamento. Irregularidades ocorreram em 88,55 por cento dos tratamentos de forma que, conforme pesos atribuídos, um bom grau de adequaçäo de uso foi observado em 355 dos casos. Os fatores relacionados à adesäo (p<0,05) foram idade menor que 5 anos, maior proporçäo de IRA/consultas realizadas no ano anterior, ter opiniäo formada sobre a razäo para cumprir a prescriçäo, bom nível de informaçöes atuais e bom grau de adequaçäo ao uso. os resultados refletem a importância de medidas garantindo que informaçöes precisas sobre antimicrobianos sejam repassadas, levando-se em conta a realidade da pessoa atendida de forma a melhorar a adesäo e otimizar o processo de atençäo à saúde