Lineamientos técnicos y operativos para la aplicación de la vacuna contra la COVID-19 - Pfizer Bivalente Hondura / Technical and operational guidelines for the application of the vaccine against COVID-19 - Pfizer Bivalent Depth

El presente lineamiento de la Vacuna contra la COVID 19 Pfizer Bivalente deberá ser utilizado por los proveedores de servicios de vacunación en Establecimientos de Salud públicos de la SESAL y del Instituto Hondureño de Seguridad Social (IHSS), para la prevención de la COVID-19, inmediatamente de la aprobación de este documento normativo. Estos lineamientos estarán vigentes mientras las características de la vacuna y la población se mantengan en las condiciones presentes en este documento...(AU)

Antibiotic consumption in secondary and tertiary hospitals in Colombia: national surveillance from 2018–2020

[ABSTRACT]. Objective. To assess the compliance in secondary and tertiary level hospitals with monthly reporting of antibi- otic consumption to the Colombian National Public Health Surveillance System (SIVIGILA-INS), and to describe reported antibiotic consumption during 2018–2020. Methods. This study involved a secondary analysis of antibiotic consumption data reported to SIVIGILA-INS. Frequency of hospital reporting was assessed and compared against expected reports, disaggregated by intensive care units (ICU)/non-ICU wards and geographical regions. Consumption was expressed as defined daily dose (DDD) per 100 occupied beds for seven antibiotics. Results. More than 70% of hospitals reported antibiotic consumption at least once in each of the three years (79% in ICU and 71% in non-ICU wards). Of these, ICU monthly reporting was complete (12 monthly reports per year) for 59% in the period 2018–2019 but only 4% in 2020. Non-ICU reporting was complete for 52% in 2019 and for 2% in 2020. Most regions had an overall decrease in reporting in 2020. Analysis of antibiotic consumption showed an increase for piperacillin/tazobactam, ertapenem, and cefepime from 2019 to 2020. Conclusions. There were gaps in the consistency and frequency of reporting. Efforts are needed to improve compliance with monthly reporting, which declined in 2020, possibly due to the COVID-19 pandemic. Non-compliance on reporting and data quality issues should be addressed with the hospitals to enable valid interpretation of antibiotic consumption trends.

[RESUMEN]. Objetivo. Evaluar el cumplimiento de los hospitales de segundo y tercer nivel en la presentación mensual de información sobre el consumo de antibióticos en el Sistema Nacional de Vigilancia en Salud Pública de Colombia (SIVIGILA-INS) y describir el consumo de antibióticos reportado en el período 2018-2020. Métodos. Este estudio incluyó un análisis secundario de los datos del consumo de antibióticos reportado en SIVIGILA-INS. Se evaluó la frecuencia de los informes hospitalarios y se comparó con los informes esperados, desglosados por unidad de cuidados intensivos (UCI) y otros servicios distintos a la UCI, y por región geográ- fica. El consumo se expresó en dosis diaria definida (DDD) por 100 camas ocupadas para siete antibióticos. Resultados. Más del 70% de los hospitales notificaron el consumo de antibióticos al menos una vez en cada uno de los tres años (79% en la UCI y 71% en los servicios distintos a la UCI). De estos, el 59% de las UCI completaron los informes mensuales (12 informes en un año) entre el 2018 y el 2019, pero solo el 4% en el 2020. El 52% de los servicios distintos a la UCI completó los informes en el 2019 y el 2% en el 2020. En la mayoría de las regiones hubo una disminución general de la notificación en el 2020. El análisis del consumo de antibióticos mostró un aumento de piperacilina/tazobactam, ertapenem y cefepima del 2019 al 2020. Conclusiones. Se encontraron disparidades en la coherencia y en la frecuencia de la presentación de informes. Es necesario destinar esfuerzos para mejorar el cumplimiento de la notificación mensual, que disminuyó en el 2020 posiblemente debido a la pandemia de COVID-19. La falta de cumplimiento en la pre- sentación de los reportes y los problemas de calidad de los datos deben abordarse con los hospitales para facilitar la interpretación válida de las tendencias de consumo de antibióticos.

[RESUMO]. Objetivo. Avaliar o cumprimento da exigência de notificar mensalmente o consumo de antibióticos em hospi- tais secundários e terciários ao Sistema Nacional de Vigilância em Saúde Pública da Colômbia (SIVIGILA-INS) e descrever o consumo informado de antibióticos de 2018 a 2020. Métodos. Este estudo envolveu uma análise secundária dos dados de consumo de antibióticos enviados para o SIVIGILA-INS. A frequência de notificação pelos hospitais foi avaliada e comparada com a frequência esperada. Os dados foram desagregados entre unidades de terapia intensiva (UTIs) e enfermarias gerais e por regiões geográficas. O consumo foi expresso como dose diária definida (DDD) por 100 leitos ocupados para sete antibióticos. Resultados. Mais de 70% dos hospitais notificaram consumo de antibióticos pelo menos uma vez em cada um dos três anos (79% na UTI e 71% nas enfermarias gerais). Entre eles, 59% dos hospitais enviaram todas as notificações relativas a UTIs (12 notificações mensais) no período de 2018 a 2019, mas apenas 4% o fiz- eram em 2020. No caso das enfermarias gerais, 52% dos hospitais enviaram todas as notificações em 2019 e 2% o fizeram em 2020. A maioria das regiões teve uma diminuição geral no número de notificações envia- das em 2020. A análise do consumo de antibióticos revelou um aumento no uso de piperacilina/tazobactam, ertapeném e cefepima de 2019 para 2020. Conclusões. Houve lacunas na uniformidade e frequência das notificações. São necessários esforços para melhorar o cumprimento da exigência de notificações mensais, que, possivelmente devido à pandemia de COVID-19, diminuiu em 2020. Problemas relacionados ao não cumprimento da exigência de notificação e à qualidade dos dados devem ser resolvidos junto aos hospitais para permitir uma interpretação válida das tendências de consumo de antibióticos.

Lineamientos para proveer la profilaxis previa a la exposición al virus de la inmunodeficiencia humana / Guidelines for providing pre-exposure prophylaxis to human immunodeficiency virus

En Honduras al igual que el resto de los países a nivel mundial, la epidemia del virus de la inmunodeficiencia humana (VIH) representa un problema de salud pública, razón por la cual es necesaria la implementación de nuevas estrategias de prevención como la profilaxis previa a la exposición (PrEP) de la infección del VIH. La PrEP es una intervención recomendada por la Organización Mundial de la Salud (OMS) y el Programa Conjunto de las Naciones Unidas sobre el VIH y Sida (ONUSIDA) para contribuir al fin de la epidemia del VIH y forma parte del conjunto de intervenciones de prevención combinada enmarcadas en los objetivos 95-95-95 para 2030...(AU)

The Effect of Online Prescription Drug Monitoring on Opioid Prescription Habits After Elective Single-level Lumbar Fusion.

INTRODUCTION: The United States opioid epidemic is a well-documented crisis stemming from increased prescriptions of narcotics. Online prescription drug monitoring programs (PDMPs) are a potential resource to mitigate narcotic misuse by tracking controlled substance prescriptions. Therefore, the purpose of this study was to evaluate opioid prescription trends after implementation of an online PDMP in patients who underwent single-level lumbar fusion. METHODS: Patients who underwent a single-level lumbar fusion between August 27, 2017, and August 31, 2020, were identified and placed categorically into one of two cohorts: an "early adoption" cohort, September 1, 2017, to August 31, 2018, and a "late adoption" cohort, September 1, 2019, to August 31, 2020. This allowed for a 1-year washout period after Pennsylvania PDMP implementation on August 26, 2016. Opioid use data were obtained by searching for each patient in the state government's online PDMP and recording data from the year before and the year after the patient's procedure. RESULTS: No significant difference was observed in preoperative opioid prescriptions between the early and late adoption cohorts. The late adoption group independently predicted decreased postoperative opioid prescriptions (ß, 0.78; 95% confidence interval [CI], 0.65 to 0.93; P = 0.007), opioid prescribers (ß, 0.81; 95% CI, 0.72 to 0.90; P < 0.001), pharmacies used (ß, 0.90; 95% CI, 0.83 to 0.97; P = 0.006), opioid pills (ß, 0.61; 95% CI, 0.50 to 0.74; P < 0.001), days of opioid prescription (ß, 0.57; 95% CI, 0.45 to 0.72; P < 0.001), and morphine milligram equivalents prescribed (ß, 0.53; 95% CI, 0.43 to 0.66; P < 0.001). CONCLUSIONS: PDMP implementation was associated with decreased postoperative opioid prescription patterns but not preoperative opioid prescribing behaviors. LEVELS OF EVIDENCE: 4.

Prescription Drug Monitoring and Child Maltreatment in the United States, 2004-2018.

OBJECTIVE: To test whether a policy approach aimed at decreasing prescription drug misuse, specifically, state monitoring of controlled substance prescriptions-prescription drug monitoring programs (PDMPs)-were associated with changes in Child Protective Services-reported maltreatment prevalence. STUDY DESIGN: Using a difference-in-differences design and maltreatment data (2004-2018) from 50 states and the District of Columbia, we compared the prevalence of total maltreatment incidents and total victims, in states with and without PDMPs, before and after implementation. Exploratory analyses further examined models disaggregated by maltreatment type (neglect, physical abuse, sexual abuse, psychological abuse) and among different racial/ethnic groups. Quasi-Poisson models included state-level covariates, state- and year-fixed effects, and cluster-robust standard errors. RESULTS: Difference-in-differences models identified greater relative reductions in PDMP states relative to controls (total prevalence ratio, 0.87; 95% CI, 0.80, 0.940; victimization prevalence ratio, 0.92; 95% CI, 0.85-0.98) over the observation period. Decreases seemed to be driven by changes in neglect (prevalence ratio, 0.87; 95% CI, 0.80-0.93) and physical abuse (prevalence ratio, 0.78; 95% CI, 0.71-0.87) incidents, and may have been especially salient for American Indian/Alaskan Native children (prevalence ratio, 0.78; 95% CI, 0.65-0.94). CONCLUSIONS: We found evidence supporting an association between prescription drug monitoring and reduced maltreatment prevalence at the state level. Policies aimed at restricting the prescribing and dispensing of controlled substances may have indirect implications for child welfare.

Effect of a Mandatory Prescription Drug Monitoring Program on Patient-initiated Phone Calls After Spine Surgery.

STUDY DESIGN: This was a retrospective cohort study. OBJECTIVE: The objective of this study was to determine the effect of a statewide, government-mandated prescription drug monitoring program (PDMP) on patient-initiated phone calls after lumbar and cervical spinal surgery. SUMMARY OF BACKGROUND DATA: Prior studies have examined the most common reasons for a postoperative phone calls, most of which pertain to pain or prescription medications. However, no studies have investigated the effects of mandatory opioid prescription reporting on these calls. METHODS: Patients who underwent lumbar decompression, lumbar fusion, or posterior cervical fusion were retrospectively identified. Patients were sorted into 1 of 2 cohorts based on their procedure date's relation to the initiation of the state's PDMP: "pre-PDMP" and "post-PDMP." All clinical and demographic data were obtained from electronic health records. Telephone communications from or on behalf of patients were retrospectively reviewed. Multivariable logistic regression was performed to determine independent factors associated with a postoperative phone call. RESULTS: Five hundred and twenty-five patients (2689 phone calls) were included in the study. Average number of phone calls per patient increased significantly after PDMP implementation among lumbar (3.27 vs. 5.18, P<0.001), cervical (5.08 vs. 11.67, P<0.001), and all (3.59 vs. 6.30, P<0.001) procedures. Age [odds ratio (OR): 1.05 (1.01, 1.09), P=0.02], cervical procedure [OR: 4.65 (1.93, 11.21), P=0.001], and a post-PDMP date of surgery [OR: 6.35 (3.55, 11.35), P<0.001] were independently associated with an increased likelihood of a postoperative phone call. A higher percentage of calls were in reference to postoperative care (4.6% vs. 2.4%, P=0.01) and wound care (4.3% vs. 1.4%, P<0.001) in the post-PDMP cohort compared with the pre-PDMP cohort. CONCLUSIONS: Patient-initiated telephone calls increased significantly after implementation of a mandatory statewide PDMP. Increasing age, operation involving the cervical spine, and surgery occurring after implementation of the state's PDMP were independently associated with an increased likelihood of postoperative phone call to health care providers.

Padrão das prescrições odontológicas de antibióticos dispensados no Sistema Único de Saúde do estado de Minas Gerais / Standard of dental prescriptions for antibiotics dispensed in the systempublic oral health services in the state of Minas Gerais

Antibióticos, juntamente com analgésicos e anti-inflamatórios, são os medicamentos mais utilizados em odontologia. A prescrição de antibióticos por cirurgiões-dentistas acontece em todo o mundo, sendo que o uso adequado desses medicamentos pode resultar em falha terapêutica, aumento do risco de reações adversas e impacto econômico, além de ser a principal causa de resistência antimicrobiana. A literatura aponta que dor de origem dental raramente é causada por uma infecção bacteriana que requer medicação antibiótica e geralmente é melhor gerenciada com o uso de analgésicos e procedimentos odontológicos locais. Os resultados de pesquisas realizadas na Inglaterra e Canadá sugerem que as prescrições de antibióticos por cirurgiões-dentistas estão aumentando de forma alarmante. Sabe-se também que o padrão de prescrição de antibióticos pode ser influenciado por fatores clínicos e não clínicos. Nesse sentido, gerar informação sobre o consumo de antibióticos é essencial para que os países adotem medidas para a conscientização da população e profissionais de saúde sobre o uso apropriado desses medicamentos, monitorem o impacto das intervenções e aprimorem o processo de aquisição, prescrição e dispensação desses medicamentos. O objetivo deste estudo foi analisar a possível associação entre prescrições odontológicas de antibióticos no setor público de um estado do sudeste brasileiro, características dos serviços de saúde e características sociais municipais. O desenho do estudo foi do tipo ecológico, o ano analisado foi o de 2017 e os dados foram obtidos do banco de dados do Sistema Integrado de Gerenciamento da Assistência Farmacêutica. A variável desfecho do primeiro artigo dessa Tese de Doutorado foi o número de Doses Diárias Definidas (DDD) por 1.000 habitantes/ano dos municípios. A variável desfecho do segundo artigo foi a adesão dos municípios a um sistema de informação de prescrições odontológicas. O banco de dados foi analisado inicialmente no programa Excel versão 2016 (Microsoft, Seattle, USA) e posteriormente no programa SPSS versão 25.0 (IBM SPSS Statistics for Windows, Armonk, NY, USA). A técnica CART (Classification And Regression Tree) foi usada para determinar a influência das características sociais dos municípios (Índice de Desenvolvimento Humano, Índice Gini, proporção de população rural, proporção de famílias beneficiárias do Programa Bolsa Família, tipologia rural/urbana, ser ou não município sede de Centro de Especialidades Odontológicas, sede de Macrorregião e Microrregião de Saúde) e das características dos serviços de saúde bucal (cobertura de saúde bucal na Estratégia Saúde da Família e na Atenção Primária à Saúde, cobertura populacional de primeira consulta odontológica, número de cirurgiões-dentistas e de equipes de saúde bucal por 1000 habitantes e percentual de procedimentos odontológicos individuais preventivos e restauradores). Os antibióticos foram os medicamentos mais prescritos pelos cirurgiões-dentistas do setor público pesquisado, sendo as penicilinas o grupo mais prescrito. A média geral de DDD/1000hab/ano, para os 421 municípios pesquisados, foi de 96,54. Fatores de organização de serviços estiveram associados à aceitabilidade dos municípios ao sistema de vigilância analisado.Concluiu-se que fatores socioeconômicos e de organização dos serviços de saúde estiveram associados à utilização de antibióticos. Há necessidade de avanços na vigilância da prescrição de antibióticos nos serviços públicos de saúde bucal do estado de Minas Gerais.

Antibiotics, along with analgesics and anti-inflammatory drugs, are the most commonly used medications in dentistry. The prescription of antibiotics by dental surgeons happens all over the world, and the irrational use of these drugs can result in therapeutic failure, increased risk of adverse reactions and economic impact, besides being the main cause of antimicrobial resistance. The literature points out that pain of dental origin is rarely caused by a bacterial infection requiring antibiotic medication and is usually best managed with the use of analgesics and local dental procedures. The results of surveys conducted in England and Canada suggest that antibiotic prescriptions by dental surgeons are increasing alarmingly. It is also known that the pattern of antibiotic prescribing can be influenced by both clinical and nonclinical factors. In this sense, generating information on antibiotic consumption is essential for countries to adopt measures to raise awareness among the population and health professionals about the appropriate use of these drugs, monitor the impact of interventions, and improve the process of acquiring, prescribing, and dispensing these drugs. The aim of this study was to analyze the possible association between dental antibiotic prescriptions in the public sector of a southeastern Brazilian state, health services characteristics, and municipal social characteristics. The study design was of the ecological type, the year analyzed was 2017, and the data were obtained from the database of the Integrated Pharmaceutical Assistance Management System. The outcome variable of the first article of this PhD Thesis was the number of Defined Daily Doses (DDD) per 1,000 inhabitants/year of the municipalities. The outcome variable of the second article was the municipalities' adherence to a dental prescription information system. The database was analyzed initially in Excel version 2016 program (Microsoft, Seattle, USA) and later in SPSS version 25.0 program (IBM SPSS Statistics for Windows, Armonk, NY, USA). The CART (Classification And Regression Tree) technique was used to determine the influence of the social characteristics of the municipalities (Human Development Index, Gini Index, proportion of rural population, proportion of beneficiary families of the Bolsa Família Program, rural/urban typology, whether or not the municipality is the headquarters of a Dental Specialties Center, seat of a Health Macro-region and Microregion) and the characteristics of oral health services (oral health coverage in the Family Health Strategy and Primary Health Care, population coverage of first dental consultation, number of dentists and oral health teams per 1000 inhabitants, and percentage of individual preventive and restorative dental procedures). Antibiotics were the most prescribed drugs by dental surgeons in the public sector surveyed, with penicillins being the most prescribed group. The overall average of DDD/1000hab/year, for the 421 municipalities surveyed, was 96.54. It was concluded that socioeconomic factors and organization of health services were associated with the use of antibiotics. There is a need for advances in the surveillance of antibiotic prescribing in public oral health services in the state of Minas Gerais.

Understanding Opioid Use After Total Hip Arthroplasty: A Comprehensive Analysis of a Mandatory Prescription Drug Monitoring Program.

INTRODUCTION: Opioids remain the most prescribed medication after total hip arthroplasty (THA) despite the potential for abuse and adverse effects. Given the high rates of opioid abuse and potential adverse effects, the reporting of controlled substances is now mandatory in many statewide databases. This study aimed to use a mandatory statewide database to analyze opioid prescription patterns in postoperative THA patients and identify independent risk factors for those patients who need a second prescription and/or require prolonged use (>6 months). METHODS: We retrospectively reviewed a consecutive series of 619 primary THAs. Demographic and comorbidity information were collected for all patients. Narcotic prescription data (converted to morphine milligram equivalents) as well as prescription data for sedatives, benzodiazepines, and stimulants were collected from the State's Controlled Substance Monitoring websites 6 months before and 9 months after the index procedure. Bivariate and multivariate analyses were done for second prescription and continued use. RESULTS: Of the 619 patients who underwent THA, 34.9% (216/619) used preoperative opioids, 36.2% (224/619) filled a second opioid prescription, and 10.5% (65/619) had continued use past 6 months. Patients with preoperative opioids were at an approximately 4-fold increased odds of requiring a second script and 12 times odds of continued opioid use. In the multivariate analysis, independent risk factors for requiring a second prescription, in descending order of magnitude, included the use of any sedative or sleep aid prescription and preoperative narcotic use. Independent risk factors for continued narcotic use longer than 6 months after THA included preoperative narcotic use and increased length of stay. DISCUSSION: Several risk factors and their relative weight have been identified for continued narcotic consumption after THA. It is important for surgeons to consider these predisposing factors preoperatively during the informed consent process and for managing postoperative pain expectations.

Atuação dos profissionais da equipe de enfermagem na farmacovigilância: revisão integrativa da literatura / Nursing team professionals"performance in pharmacovigilance: an integrative literature review

Este estudo teve por objetivo caracterizar a prática dos profissionais de enfermagem na farmacovigilância a partir da produção científica nacional e internacional dos últimos 10 anos. Revisão integrativa da literatura realizada no período de agosto a novembro de 2018 nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, Base de Dados de Enfermagem, Scientific Electronic Library Online e Medical Literature Analysis and Retrieval System Online, através de descritores preestabelecidos nos Descritores em Ciências da Saúde e cruzados por meio do operador booleano AND. Dos 57 artigos iniciais, 13 compuseram o corpus da pesquisa. Após análise temática e categorização, a atuação dos profissionais de enfermagem contemplou as categorias Atuação assistencial da enfermagem na farmacovigilância e Atuação gerencial e educacional da enfermagem na farmacovigilância. Apesar de limitada e pouco concreta, a atuação da equipe de enfermagem se apresentou na linha de frente da vigilância do consumo de medicamentos.

New Mexico Nurse-Midwives' Controlled Substance Prescribing and Monitoring Practices.

INTRODUCTION: New Mexico, a state with a high incidence of opioid overdose deaths, requires certified nurse-midwives (CNMs) who prescribe controlled substances to use the statewide Prescription Monitoring Program (PMP). This study examined how frequently CNMs who practice in New Mexico and prescribe controlled substances use the PMP and the purposes for which they use it. METHODS: All CNMs licensed in New Mexico (N = 210) were sent a link to an anonymous online survey. CNM demographics, practice characteristics, and controlled substance prescribing practices were examined. RESULTS: Approximately 40% of CNMs licensed in New Mexico completed the survey (N = 83), 77% of whom (64/83) were providing direct clinical care services. Nearly all who were engaged in clinical care had a US Drug Enforcement Administration registration number and were registered in the PMP (97%; 62/64). Approximately 90% of those respondents (56/62) reported prescribing controlled substances. Approximately 10% (6/62) never logged into the PMP, 40% (25/62) never ran a self-report, and nearly 30% (18/62) reported never checking the PMP for patient alerts. Among those who reported prescribing controlled substances, the percentages who never logged in, never ran a self-report, and never checked for patient alerts were 7% (4/56), 37% (21/56), and 27% (15/56), respectively. Nearly half of those prescribing controlled substances (26/56) did so monthly or more often, but with respect to their own prescribing, approximately one-third of them (9/26) checked the PMP less frequently than every 6 months. DISCUSSION: Most CNMs in New Mexico are authorized to prescribe controlled substances, but the frequency of prescribing varies, and some CNMs may not be making optimal use of the state PMP for self-reports, for patient alerts, or prior to prescribing a controlled substance. Additional education pertaining to the PMP is needed, as are best practice recommendations for monitoring CNMs' controlled substance prescribing.

Problemas relacionados a medicamentos em idosos usuários de psicotrópicos: revisão integrativa de literatura / Problems related to drugs in elderly users of psychotropic drugs: an integrative literature review / Problemas relacionados a medicamentos en ancianos usuarios de psicotrópicos: revisión integrativa de literatura

Revisão integrativa da literatura realizada na Biblioteca Virtual em Saúde (BVS), buscou identificar os principais problemas relacionados ao uso de psicotrópicos em idosos e propor soluções. Os principais problemas identificados foram reações adversas, risco de quedas e interações medicamentosas. Foram sugeridas três propostas para a redução de suas ocorrências: a adoção de um programa de prescrição eletrônica, a adoção de medidas educativas e/ou realização de acompanhamento farmacoterapêutico com estes pacientes.

An integrative review of the literature carried out in the "Biblioteca Virtual em Saúde" (BVS), sought to identify the main problems related to the use of psychotropic drugs in the elderly and propose solutions. The main problems identified were adverse reactions, risk of falls and drug interactions. Three proposals were suggested to reduce their occurrences: the adoption of an electronic prescription program, the adoption of educational measures and / or pharmacotherapeutic follow-up with these patients.

Revisión integrativa de la literatura realizada en la "Biblioteca virtual em saúde" (BVS,) buscó identificar los principales problemas relacionados al uso de psicotrópicos en ancianos y proponer soluciones. Los principales problemas identificados fueron reacciones adversas, riesgo de caídas e interacciones medicamentosas. Se sugirieron tres propuestas para la reducción de sus ocurrencias: la adopción de un programa de prescripción electrónica, adopción de medidas educativas y / o realización de seguimiento farmacoterapéutico con estos pacientes.

Evaluación del consumo de antimicrobianos en una Unidad de Neonatologia: un trabajo en equipo para promover el uso racional de antimicrobianos / Evaluation of antimicrobial consumption in a Neonatology Unit: a team work to promote the rational use of antibiotics

Resumen Antecedentes: Los antimicrobianos (ATM) son uno de los medicamentos más utilizados en recién nacidos (RN) hospitalizados. El uso indiscriminado de ATM trae consecuencias negativas como son el predominio de bacterias resistentes a los ATM usualmente utilizados y asociaciones individuales a morbilidad relevante como son la displasia broncopulmonar, enterocolitis necrosante, sepsis tardía y/o muerte. Objetivo: Registrar y evaluar las tendencias del uso de ATM a lo largo del tiempo en RN hospitalizados en el Servicio de Neonatología (SRN) del Complejo Asistencial Dr. Sótero del Río, con el fin de objetivar los cambios en la práctica habitual de la indicación de ATM. Un objetivo secundario fue evaluar el impacto de estas conductas sobre la resistencia antimicrobiana. Métodos: Estudio de cohorte, prospectivo, observacional, unicéntrico, en todos los pacientes hospitalizados entre enero de 2011 y diciembre de 2014. Se registró el peso al nacer, días de hospitalización, indicación y días de uso de ATM para cada paciente. El uso de ATM fue cuantificado por medio de distintas tasas: días de indicación de un o más ATM para el consumo global (TUA), sumatoria total de días de uso (STUA) como para los ATM más frecuentemente utilizados. Cada tasa calculada por 100 días hospitalizados. Además, se registró la susceptibilidad antimicrobiana de las bacterias más frecuentemente aisladas en nuestro servicio: Staphylococcus coagulasa negativa (SCN) y bacilos gramnegativos (BGNs). Resultados: El 34,7% de los pacientes hospitalizados recibió algún tipo de antimicrobiano, correspondiendo 32,3% a antibacterianos. El ATM más utilizado fue ampicilina (20,2% del total) y luego cefadroxilo (11,6%). El TUA no cambió entre 2011 y 2014. La STUA disminuyó en 10,7% entre 2011 y 2014 (p < 0,05). En el análisis por rangos de peso, en el grupo < 750 g disminuyó la tendencia de uso de vancomicina (descenso de uso en 9,9%) y un aumento de 18,8% para metronidazol. Por otra parte, hubo un aumento en el uso del régimen de piperacilina/tazobactam en el grupo > 1.500 g. Al evaluar la susceptibilidad antimicrobiana, hubo una disminución de la susceptibilidad a cloxacilina en SCN entre 2011 y 2014 desde 27 a 10,3%, respectivamente. Para BGN hubo una disminución desde 76,9 a 40,5% en la susceptibilidad a cefalosporinas de tercera generación, principalmente debido a Klebsiella pneumoniae que pasó a ser el BGN predominante, con un aumento de 6,7 a 50% en los años 2011 y 2014, respectivamente. Para Klebsiella pneumoniae la susceptibilidad a cefalosporinas de tercera generación descendió desde 77 a 22%. Por último, amikacina mostró una actividad sobre 85% en todos los BGNs entre 2011 y 2014. Conclusiones: Es recomendable planificar y mantener un registro continuo del consumo de ATM tanto como terapia y profilaxis, idealmente llevar el TUA, el STUA y siendo categorizado por tipo de ATM y rango de peso de los RN. En forma concomitante, es de considerable importancia analizar y evaluar la susceptibilidad de microorganismos. Es esencial que un equipo interdisciplinario prepare este registro, y que continuamente proporcione retroalimentación a los profesionales que mantienen el funcionamiento de las unidades de cuidados neonatales.

Background: Antibiotics (ATB) are drugs widely used in hospitalized newborns. The indiscriminate use of ATBs promote the rise of resistant bacteria to the most commonly indicated antimicrobials. In addition, ATB prescription presents associations to morbidity, such as bronchopulmonary dysplasia, necrotizing enterocolitis, late sepsis and even death. All of the above leads to an increase in health care costs. Aim: To record and to evaluate trends of antibiotic use over time in hospitalized NB in the Neonatology Unit at Dr. Sótero del Río Hospital, in order to objectify the changes in the usual practice of the ATM indication. A secondary objective was to assess its impact on antimicrobial resistance. Methods: Cohort, observational, prospective unicenter study which included all hospitalized patients between January 2011 and December 2014. Birth weight, hospitalization days, ATB indication and days of ATB use were recorded for each patient. The use of ATB was quantified by means of different rates; days of indication of one or more ATBs for global consumption (RUA), total sum of days of use (TSUA) and for the most frequently used ATBs. Each calculated rate for 100 days hospitalized. In addition, the antimicrobial susceptibility of the most frequently isolated bacteria in our service: coagulase-negative Staphylococcus (SCN) and Gram-negative bacilli (BGN) were recorded continuously. Results: The 34.7% of the hospitalized patients received some type of antimicrobial agent. ATBs were 32.3% of medicines used. The most widely used was ampicillin (with 20.2% of the total) and cefadroxyl (with 11.6%). The RUA did not change during the study time, but STUA decreased by 10.7% between 2011 and 2014 with p < 0.05. When subgroup analyzes were divided by weight ranges, in the < 750 g group, the use of vancomycin decreased in use by 9.9% and an increase of 18.8% for metronidazole was observed. On the other hand, there was an increase in the use of the piperacillin-tazobactam regimen in the range > 1,500 g. When evaluating antimicrobial susceptibility, there was a decrease in susceptibility for oxacillin in SCN between 2011 and 2014 from 27% to 10.3% respectively. In addition, for Gram negative there was a decrease from 76.9% to 40.5% in susceptibility to third generation cephalosporins, mainly due to Klebsiella pneumoniae, which became the predominantly isolated BGN with an increase of 6.7% to 50% between 2011 and 2014, respectively. For K. pneumoniae the loss of susceptibility to third generation cephalosporins decreased from 77% to 22%. Finally, amikacin showed an activity over 85% in all BGNs between 2011 and 2014. Conclusions: It is advisable to plan and to maintain a continuous record of ATB consumption, as well as therapy and prophylaxis, being categorized by ATB type and range of newborn weight. It is of considerable importance to analyze and to evaluate the susceptibility of microorganisms. It is essential that an interdisciplinary team prepare this recording, and to continuously provide feedback to professionals who maintain the functioning of neonatal care units.

[Evaluation of antimicrobial consumption in a Neonatology Unit: a team work to promote the rational use of antibiotics]. / Evaluación del consumo de antimicrobianos en una Unidad de Neonatologia: un trabajo en equipo para promover el uso racional de antimicrobianos.

BACKGROUND: Antibiotics (ATB) are drugs widely used in hospitalized newborns. The indiscriminate use of ATBs promote the rise of resistant bacteria to the most commonly indicated antimicrobials. In addition, ATB prescription presents associations to morbidity, such as bronchopulmonary dysplasia, necrotizing enterocolitis, late sepsis and even death. All of the above leads to an increase in health care costs. AIM: To record and to evaluate trends of antibiotic use over time in hospitalized NB in the Neonatology Unit at Dr. Sótero del Río Hospital, in order to objectify the changes in the usual practice of the ATM indication. A secondary objective was to assess its impact on antimicrobial resistance. METHODS: Cohort, observational, prospective unicenter study which included all hospitalized patients between January 2011 and December 2014. Birth weight, hospitalization days, ATB indication and days of ATB use were recorded for each patient. The use of ATB was quantified by means of different rates; days of indication of one or more ATBs for global consumption (RUA), total sum of days of use (TSUA) and for the most frequently used ATBs. Each calculated rate for 100 days hospitalized. In addition, the antimicrobial susceptibility of the most frequently isolated bacteria in our service: coagulase-negative Staphylococcus (SCN) and Gram-negative bacilli (BGN) were recorded continuously. RESULTS: The 34.7% of the hospitalized patients received some type of antimicrobial agent. ATBs were 32.3% of medicines used. The most widely used was ampicillin (with 20.2% of the total) and cefadroxyl (with 11.6%). The RUA did not change during the study time, but STUA decreased by 10.7% between 2011 and 2014 with p < 0.05. When subgroup analyzes were divided by weight ranges, in the < 750 g group, the use of vancomycin decreased in use by 9.9% and an increase of 18.8% for metronidazole was observed. On the other hand, there was an increase in the use of the piperacillin-tazobactam regimen in the range > 1,500 g. When evaluating antimicrobial susceptibility, there was a decrease in susceptibility for oxacillin in SCN between 2011 and 2014 from 27% to 10.3% respectively. In addition, for Gram negative there was a decrease from 76.9% to 40.5% in susceptibility to third generation cephalosporins, mainly due to Klebsiella pneumoniae, which became the predominantly isolated BGN with an increase of 6.7% to 50% between 2011 and 2014, respectively. For K. pneumoniae the loss of susceptibility to third generation cephalosporins decreased from 77% to 22%. Finally, amikacin showed an activity over 85% in all BGNs between 2011 and 2014. CONCLUSIONS: It is advisable to plan and to maintain a continuous record of ATB consumption, as well as therapy and prophylaxis, being categorized by ATB type and range of newborn weight. It is of considerable importance to analyze and to evaluate the susceptibility of microorganisms. It is essential that an interdisciplinary team prepare this recording, and to continuously provide feedback to professionals who maintain the functioning of neonatal care units.

Efectividad de un programa de control de antimicrobianos en una unidad de cuidados críticos en Cuba / Effectiveness of a program of antimicrobial control in a critical care unit in Cuba

Objetivo: evaluar el impacto de un programa de control de antimicrobianos en pacientes críticos. Métodos: estudio de intervención realizado en las unidades de cuidados críticos del Hospital Docente Clínicoquirúrgico Joaquín Albarrán. Fueron evaluados 35 pacientes en el período preintervención (1-5-2008/31-7-2008) y 241 pacientes en el período de intervención (1-8-2010/30-5-2010). Se implementa un programa multidimensional de control de la calidad de uso de antimicrobianos, incluyendo medidas organizacionales y educativas. La calidad de la prescripción fue evaluada por expertos en los pacientes ingresados un día al mes durante el período de estudio. Se determinó la proporción de pacientes en los que se demuestra prescripción inadecuada de antimicrobianos, la proporción de pacientes que utilizan antibióticos seleccionados, así como la frecuencia de errores de prescripción según tipo. Se realizaron comparaciones de los indicadores en los períodos preintervención y de intervención. Resultados: no se observan diferencias en las características demográficas de los pacientes, el diagnóstico principal al egreso y los antecedentes patológicos en los períodos de estudio. Las cefalosporinas constituyen el grupo de antimicrobianos más utilizado, aunque se observa una disminución en la frecuencia de uso(AU)

Objective: to assess the impact of antimicrobial control on the critical patients. Methods: an intervention study was conducted in the critical care units of the Joaquín Albarrán Clinical Surgical University Hospital. Thirty five patients was assessed during the pre-intervention period (1-5-2008/31-7-2008) and 241 patients during the intervention period (1-8-2010/20-5-2010). A multidimensional program of quality control of use of antimicrobials including an organizing educational measurements. The quality of prescription was assessed by experts in the patients admitted a day at month during study period. The ratio of patients with an inappropriate antimicrobial prescription, the ratio of patients using selected antibiotics was determined as well as the error frequency of the prescription according the type. Authors made comparisons of indicators during the pre-intervention and intervention periods. Results: there were not differences in the demographic features of patients, the leading diagnosis at admission and the pathological backgrounds during study periods(AU)