ABSTRACT
BACKGROUND: Antimicrobial stewardship programs (ASPs) have become a fundamental pillar in optimizing antimicrobial usage, improving patient care, and reducing antimicrobial resistance (AMR). Herein we evaluated the impact of an ASP on antimicrobial consumption and AMR in Colombia. METHODS: We designed a retrospective observational study and measured trends in antibiotic consumption and AMR before and after the implementation of an ASP using interrupted time series analysis over a 4-year period (24 months before and 24 months after ASP implementation). RESULTS: ASPs were implemented according to the available resources in each of the institutions. Before ASP implementation, there was a trend toward an increase in the antibiotic consumption of all measured antimicrobials selected. Afterward, an overall decrease in antibiotic consumption was observed. The use of ertapenem and meropenem decreased in hospital wards, while a decrease in the use of ceftriaxone, cefepime, piperacillin/tazobactam, meropenem, and vancomycin was observed in intensive care units. After ASP implementation, the trend toward an increase of oxacillin-resistant Staphylococcus aureus, ceftriaxone-resistant Escherichia coli, and meropenem-resistant Pseudomonas aeruginosa was reversed. CONCLUSIONS: In our study, we showed that ASPs are a key strategy in tackling the emerging threat of AMR and have a positive impact on antibiotic consumption and resistance.
Subject(s)
Anti-Infective Agents , Antimicrobial Stewardship , Methicillin-Resistant Staphylococcus aureus , Anti-Bacterial Agents/therapeutic use , Ceftriaxone , Colombia , Delivery of Health Care , Drug Resistance, Bacterial , Humans , Meropenem/therapeutic useABSTRACT
Objective. To evaluate the incidence of adverse cutaneous drug reactions in intensive care unit patients. Design. Cohort study. Setting. General adult intensive care unit of an institutional tertiary care hospital. Patients. Patients in the intensive care unit during a consecutive 8-month period were examined for adverse cutaneous drug reactions. Results. Patients in the intensive care unit have an incidence of 11.6% of adverse cutaneous drug reactions. Associated risk factors were female gender, obesity, age over 60 and immune dysregulation (systemic lupus erythematosus, dysthyroidism, and antiphospholipid antibodies syndrome). Few patients had previous history of adverse cutaneous drug reactions. Antimicrobials were the main drug involved. Morbilliform rash followed by urticary were the most frequently observed reactions. Interestingly, over 50% of patients with massive edema -independent of etiology- died. Conclusions. Intensive care unit patients are particularly at risk for developing an adverse cutaneous drug reaction.
Se realizó un estudio de cohorte en la Unidad de Terapia Intensiva (UTI) de un hospital de tercer nivel para evaluar la incidencia de reacciones cutáneas adversas a drogas. Se examinaron todos los pacientes internados en dicha unidad durante un periodo consecutivo de ocho meses. Observamos una incidencia de reacciones adversas a medicamentos de 11.6%. Los factores de riesgo asociados fueron sexo femenino, obesidad, edad mayor a 60 años y alteraciones inmu-nológicas (lupus eritematoso sistémico, distiroidismo y síndrome de antifosfolípido). Los antimicrobianos fueron los principales medicamentos involucrados. La erupción morbiliforme y la urticaria fueron las reacciones más frecuentes. Un hallazgo interesante fue que más de 50% de los pacientes con anasarca fallecieron. Concluimos que los pacientes internados en la UTI son particularmente susceptibles para desarrollar una reacción adversa cutánea a medicamentos.