Impacto de un programa de optimización de antimicrobianos sobre el paciente crítico hematológico

Jesus Ruiz-Ramos; Juan Frasquet; Jose Luis Poveda-Andrés; Eva Romá; Miguel Salavert-Lleti; Álvaro Castellanos; Paula Ramirez

doi:10.7399/fh.2017.41.4.10709

Impacto de un programa de optimización de antimicrobianos sobre el paciente crítico hematológico

Jesus Ruiz-Ramos, Juan Frasquet, Jose Luis Poveda-Andrés, Eva Romá, Miguel Salavert-Lleti, Álvaro Castellanos, Paula Ramirez

Resumen

Introducción: Los programas de optimización de antimicrobianos (PROA) han surgido como herramientas de gran utilidad para mejorar el uso de estos. El objetivo del presente estudio es evaluar el impacto de un PROA sobre pacientes hematológicos ingresados en una unidad de pacientes críticos.

Material y métodos: Estudio cuasi-experimental pre-post intervención. Se incluyeron pacientes hematológicos ingresados en una unidad de críticos evaluados por el equipo PROA durante 3 años. El impacto del programa sobre la evolución de los pacientes se evaluó mediante la comparación entre el periodo previo y de intervención de la mortalidad, estancia media, número de reingresos y duración de ventilación mecánica en los pacientes intubados.

Resultados: 324 antimicrobianos de 169 pacientes fueron evaluaron por el equipo PROA, recomendando un total de 121 modificaciones, incluyendo 55 suspensiones de tratamiento. Comparados con el periodo pre-intervención, no se observaron diferencias significativas en las variables consideradas. No se observó variación en la colonización por bacterias multirresistentes.

Conclusiones: La implantación de un PROA sobre el paciente crítico hematológico conduce a un número relevante de modificaciones en el tratamiento, sin afectar la evolución clínica de los pacientes.

Palabras clave

Programas de optimización de antimicrobianos; Enfermedad hematológica; Paciente crítico; Bacterias multirresistentes.

Texto completo:

PDF (English)

Referencias

Klastersky J, Ameye L, Maertens J, Georgala A, Muanza F, Aoun M, et al. Bacteraemia in febrile neutropenic cancer patients. Int J Antimicrob Agents. 2007; 30 Suppl 1:S51-9.

Kang C-I, Song J-H, Chung DR, Peck KR, Ko KS, Yeom J-S, et al. Risk factors and pathogenic significance of severe sepsis and septic shock in 2286 patients with gram-negative bacteremia. J Infect. 2011; 62(1):26- 33.

Jeddi R, Achour M, Amor RB, Aissaoui L, Bouterâa W, Kacem K, et al. Factors associated with severe sepsis: prospective study of 94 neutropenic febrile episodes. Hematol Amst Neth. 2010; 15(1):28-32.

Cornely OA, Maertens J, Winston DJ, Perfect J, Ullmann AJ, Walsh TJ, et al. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med. 2007; 356(4):348-59.

Maschmeyer G, Haas A, Cornely OA. Invasive aspergillosis: epidemiology, diagnosis and management in immunocompromised patients. Drugs. 2007; 67(11):1567-601.

Tatarelli P, Mikulska M. Multidrug-resistant bacteria in hematology patients: emerging threats. Future Microbiol. 2016; 11:767-80.

Pouch SM, Satlin MJ. Carbapenem-Resistant Enterobacteriaceae in Special Populations: Solid Organ Transplant Recipients, Stem Cell Transplant Recipients, and Patients with Hematologic Malignancies. Virulence. 2016; 28:1-12.

Baker TM, Satlin MJ. The growing threat of multidrug-resistant Gram- negative infections in patients with hematologic malignancies. Leuk Lymphoma. 2016; 57(10):2245-58.

Wagner B, Filice GA, Drekonja D, Greer N, MacDonald R, Rutks I, et al. Antimicrobial stewardship programs in inpatient hospital settings: a systematic review. Infect Control Hosp Epidemiol. 2014; 35(10):1209-28.

Luyt C-E, Bréchot N, Trouillet J-L, Chastre J. Antibiotic stewardship in the intensive care unit. Crit Care Lond Engl. 2014; 18(5):480.

Rodríguez-Baño J, Paño-Pardo JR, Alvarez-Rocha L, Asensio Á, Calbo E, et al; GEIHSEIMC; SEFH; SEMPSPH. Programs for optimizing the use of antibiotics (PROA) in Spanish hospitals: GEIH-SEIMC, SEFH and SEMPSPH consensus document. Farm Hosp 2012; 36: 33.e1-30.

Chung GW, Wu JE, Yeo CL, Chan D, Hsu LY. Antimicrobial stewardship: a review of prospective audit and feedback systems and an objective evaluation of outcomes. Virulence. 2013; 4(2):151-7.

Baker TM, Satlin MJ. The growing threat of multidrug-resistant Gram- negative infections in patients with hematologic malignancies. Leuk Lymphoma. 2016; 57(10):2245-58.

Falagas ME, Rafailidis PI, Kofteridis D, Virtzili S, Chelvatzoglou FC, Papaioannou V, et al. Risk factors of carbapenem-resistant Klebsiella pneumoniae infections: a matched case control study. J Antimicrob Chemother. 2007 Nov; 60(5):1124-30.

Schwaber MJ, Klarfeld-Lidji S, Navon-Venezia S, Schwartz D, Leavitt A, Carmeli Y. Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality. Antimicrob Agents Chemother. 2008; 52(3):1028-33.

Patel G, Huprikar S, Factor SH, Jenkins SG, Calfee DP. Outcomes of carbapenemresistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol. 2008; 29(12):1099-106.

Gudiol C, Tubau F, Calatayud L, Garcia-Vidal C, Cisnal M, Sánchez- Ortega I, et al. Bacteraemia due to multidrug-resistant Gram-negative bacilli in cancer patients: risk factors, antibiotic therapy and outcomes. J Antimicrob Chemother. 2011; 66(3):657-63.

Tumbarello M, Spanu T, Caira M, Trecarichi EM, Laurenti L, Montuori E, et al. Factors associated with mortality in bacteremic patients with hematologic malignancies. Diagn Microbiol Infect Dis. 2009; 64(3):320-6.

Mertz D, Brooks A, Irfan N, Sung M. Antimicrobial stewardship in the intensive care setting--a review and critical appraisal of the literature. Swiss Med Wkly. 2015; 145:w14220.

Tabah A, Cotta MO, Garnacho-Montero J, Schouten J, Roberts JA, Lipman J, et al. A Systematic Review of the Definitions, Determinants, and Clinical Outcomes of Antimicrobial De-escalation in the Intensive Care Unit. Clin Infect Dis. 2016; 62(8):1009-17.

Katsios CM, Burry L, Nelson S, Jivraj T, Lapinsky SE, Wax RS, et al. An antimicrobial stewardship program improves antimicrobial treatment by culture site and the quality of antimicrobial prescribing in critically ill patients. Crit Care. 2012;16(6):R216.

Candeloro CL, Kelly LM, Bohdanowicz E, Martin CM, Bombassaro AM. Antimicrobial use in a critical care unit: a prospective observational study. Int J Pharm Pract. 2012; 20(3):164-71.

Lodise TP, Drusano GL. Pharmacokinetics and pharmacodynamics: optimal antimicrobial therapy in the intensive care unit. Crit Care Clin. 2011; 27(1):1-18.

Maseda E, Salgado P, Anillo V, Ruiz-Carrascoso G, Gómez-Gil R, Martín-Funke C, et al. Risk factors for colonization by carbapenemase- producing enterobacteria at admission to a Surgical ICU: A retrospective study. Enferm Infecc Microbiol Clin. 2016; pii: S0213-005X(16)30002-7.

Vasudevan A, Mukhopadhyay A, Li J, Yuen EGY, Tambyah PA. A prediction tool for nosocomial multi-drug Resistant Gram-Negative Bacilli infections in critically ill patients - prospective observational study. BMC Infect Dis. 2014; 14:615.

Russotto V, Cortegiani A, Raineri SM, Giarratano A. Bacterial contamination of inanimate surfaces and equipment in the intensive care unit. J Intensive Care 2015;3:54.

DiazGranados CA. Prospective audit for antimicrobial stewardship in intensive care: impact on resistance and clinical outcomes. Am J Infect Control. 2012;40(6):526-9.

Güerri-Fernández R, Villar-García J, Herrera-Fernández S, Trenchs- Rodríguez M, Fernández-Morato J, Moro L, et al. An antimicrobial stewardship program reduces antimicrobial therapy duration and hospital stay in surgical wards. . Rev Esp Quimioter. 2016; 29:119-21.

Elligsen M, Walker SA, Pinto R, Simor A, Mubareka S, Rachlis A et al. Audit and feedback to reduce broad spectrum antibiotic use among intensive care unit patients: a controlled interrupted time series analysis. Infect Control Hosp Epidemiol. 2012; 33:354-61.

Taggart LR, Leung E, Muller MP, Matukas LM, Daneman N. Differential outcome of an antimicrobial stewardship audit and feedback program in two intensive care units: a controlled interrupted time series study. BMC Infect Dis. 2015; 15:480.

Azoulay E, Mokart D, Pène F, Lambert J, Kouatchet A, Mayaux J, et al. Outcomes of Critically Ill Patients With Hematologic Malignancies: Prospective Multicenter Data From France and Belgium–A Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique Study. J Clin Oncol. 2013; 31:2810-8.

Montero JG, Lerma FÁ, Galleymore PR, Martínez MP, Rocha LÁ, Gaite FB, et al. Combatting resistance in intensive care: the multimodal approach of the Spanish ICU “Zero Resistance” program. Crit Care. 2015; 16; 19:114.

DOI: http://dx.doi.org/10.7399%2Ffh.2017.41.4.10709