Uticaj razlika u propisivanju antimikrobnih lekova na učestalost multirezistentnih patogena na hirurškim i internističkim odeljenjima
Influence of differences in prescribing antimicrobial drugs on isolation rate of multidrug resistant pathogens on surgical and medical wards
Докторанд
Živanović, VladimirМентор
Šćepanović, RadisavЧланови комисије
Gojković-Bukarica, Ljiljana![](/themes/MirageNardus/images/orcid.png)
Đukić, Slobodanka
Perunović, Radoslav
Dragovac, Gorana
Метаподаци
Приказ свих података о дисертацијиСажетак
Savremena terapija infekcija podrazumeva zauzimanje zajedničkog stava/strategije o tome
koji će se antimikrobni lekovi koristiti, pa se u skladu sa tim formira sopstveni lokalni vodič
za primenu ovih lekova usklađen sa osetljivošću multirezistentnih (MDR) patogena prisutnih
na različitim bolničkim odeljenjima. Za izradu lokalnog vodiča je neophodno prikupiti
podatke o potrošnji i navikama propisivanja antimkrobnih lekova i o prevalenciji MDR
patogena kao što su Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter
baumannii i Escherichia coli.
Izolati navedenih MDR patogena su praćeni na hirurškim (S) i internističkim (M) odeljenjima
Kliničko-bolničkog centra „Dr Dragiša Mišović-Dedinje“ u periodu od 2012. do 2015.
godine. Procena pravilnog propisivanja antimikrobnih lekova je zasnovana na metodologiji
Global-Point Prevalence Survey koja je dizajnirana u Antverpu (Belgija).
Procenat MDR patogena u odnosu na ukupan broj izolata K.pneumoniae - P.aeruginosa je
značajno veći na S (8...6,2% i 49,1%) nego na M (63,2% i 36,9%) odeljenjima. Procenat MDR
A.baumannii nije signifikantno različiti između S (93,7%) i M (79,5%) odeljenjima. U
posmatranom periodu, postoji statistički značajan porast prevalencije MDR E.coli na S i M
odeljenju (p<0,001).
Ukupna potrošnja antibiotika (određena kao definisana dnevna doza na 100 bolesničkih
postelja) za četiri godine je 369,7 i 261,5 na S i M odeljenjima, redom. Analizirano je ukupno
225 epizoda propisivanja antimikrobnih lekova u 138 lečenih odraslih pacijenata. Procenat
propisivinja antimikrobnih lekova kao profilakse je 75% i 0%, na S i M odeljenjima, redom.
Terapija je bila češće empirijska nego kauzalna (S, 86,8% i M, 80%). Procenat greške u
propisivanju na S i M odeljenjima je bio 74,6% i 27,3%, redom.
Indikatori kvaliteta, za propisivanje antimikrobnih lekova na S i M odeljenjima, su:
neadekvatan izbor antimikrobnog leka (35,6% vs. 20,0%), neadekvatni dozni interval (70,6%
vs. 16,9%) i dužina primene (72,5% vs. 23,1%), nedokumentovan start/stop terapije (73,6%
vs. 16,9%) i odstupanje od vodiča (71,9% vs. 23,1%). Terapija zasnovana na biomarkerima
je bila češća na M odeljenjima u odnosu na S odeljenja. Porast prevalencije MDR patogena, visoka potrošnja i neadekvatno propisivanje
antimikrobnih lekova traži posebne mere opreza a pre svega na S odeljenjima.
Contemporary antimicrobial therapy is based on unified decision/strategy about which
antimicrobial drugs and how will be used, accordance to own guideline made on local
proportion of multiple resistant drug isolates gathered on difference wards. In order to provide
guidance data for clinically rational use of an antibiotics, consumption, prescribing and
prevalence of multidrug resistant (MDR) Klebsiella pneumoniae, Pseudomonas aeruginosa,
Acinetobacter baumannii and Escherichia coli were monitored on the surgical (S) and
medical (M) wards of the University Hospital Center „Dr. Dragiša Mišović-Dedinje“
(Belgrade, Serbia), in the study period from 2012. to 2015. Appropriateness of antimicrobial
use was evaluatedusing the Global-Point Prevalence Survey method designed by the
University of Antwerp.
The percentages of MDR pathogens relative to the total number of isolates of K. pneumoniae
and P. aeruginosa were higher on the S (86.2% and 49.1%) than on the M (63.2% and 36.9%)
wards. The per...centage of MDR A. baumannii was not different with statistical significance,
between S (93.7%) and M (79.5%) wards. During the observed period, we recognize
statistically significant increase in prevalence of MDR E.coli both on S and M wards.
An overall antibiotics consumption (defined daily doses/100 beddays) during study was 369.7
and 261.5 on the S and M wards, respectively. A total of 225 prescriptions of antimicrobials
were evaluated in138 adults admitted to wards. The percentage of antimicrobials prescribed
for prophylaxis on the M and S wards were 0% and 75%, respectively. Therapies were more
frequently empiric (S, 86.8% and M, 80%). The percentages of medical errors on the S and M
wards were 74.6% and 27.3%, respectively.
The quality indicators for antibiotic prescribing on the S and M wards were as follows: the
incorrect choice of antimicrobials (35.6% vs. 20.0%), inappropriate dose interval (70.6% vs.
16.9%) or duration of therapy (72.5% vs. 23.1%), a nondocumented stop/review data (73.6%
vs. 16.9%) and divergence from guidelines (71.9% vs. 23.1%). Treatment based on
biomarkers was more common on the M wards as compared to the S wards.
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The increasing prevalence of MDR pathogens, a very high consumption and incorrect
prescribing of antimicrobials need special attention, particularly on the S wards.