Intervención en el servicio de urología mediante un programa de optimización del uso de antimicrobianos

Resumen

INTRODUCTION Advances in the treatment of infectious diseases and the spread of antimicrobial resistance create complexity in the proper use of antimicrobials. Programs for optimizing the use of antimicrobials aim to improve their suitability and reduce the negative ecological impact of their use. Spain has one of the highest consumption of antimicrobials in the world. It is estimated that up to 45% of patients admitted to Spanish hospitals receive at least one dose of antibiotics during their stay. In surgical services, the prevalence of patients with antimicrobial treatment has been measured at approximately 54%. OBJECTIVES - To develop and implement a program to optimize the use of antimicrobials in the Urology service of the Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA). - To analyze the adequacy of the antibiotic treatment prescribed in the Urology service as antibiotic prophylaxis, empirical treatment and directed in the pre-PROA-U and PROA-U period. - To identify the main bacteria and antimicrobial resistance in this service, during both periods. - To analyze the consumption, the prevalence of antimicrobial use and the associated pre- and post-intervention cost. MATERIAL AND METHODS Two cohorts are analyzed. A retrospective, pre-PROA-U, where no type of intervention was performed, compared to a prospective, PROA-U, where the cases included were evaluated on a daily basis by a urology physician with the support of the PROA team of the HCUVA. All statistical analyses were performed following the usual concepts for the study of quantitative and qualitative variables, setting the level of statistical significance at p<0.05 (95% confidence interval) and using the statistical program IBM SPSS Statistics for Macintosh, Version 28.0 (IBM Corp. Armonk, N.Y, USA). RESULTS The general acceptance of the intervention in the service was 87.84% of the recommendations made during PROA-U. Better adequacy was obtained in empirical treatment (86.98% vs. 46.98%) and directed (90.57% vs. 39.58%) in the PROA-U period. There were no significant changes in the use of surgical prophylaxis (96.6% pre-PROA-U vs. 90.20% PROA-U). During both periods, the distribution of microorganisms was similar, with Escherichia coli and Klebsiella pneumoniae in the lead, and with resistance similar to that found in the HCUVA annual susceptibility report. We observed a reduction in the averages of the DDD/100 stays of amoxicillin-clavulanate, meropenem, ciprofloxacin and ceftriaxone, but did not find this reduction in the case of piperacillin-tazobactam. In the global calculation of the consumption of antimicrobials in the pre-PROA-U period, it amounted to 3,192.57 euros compared to 2,687.62 euros in the PROA-U period. CONCLUSIONS This PROA model, in which a surgical physician is integrated into the team, allows us to optimize communication and identify points for improvement in clinical practice. Daily control of the use of antimicrobials makes it possible to reduce the use of certain molecules (especially in scheduled surgical procedures) and the cost derived from them.