Analysis of the use of imipenem at a University Hospital following the restructuring of an antimicrobial audit system

This study analyzed the use pattern of imipenem following the restructuring of the antimicrobial audit system at a University Hospital. It was an observational study before and after the restructuring of the antimicrobial audit system in a University Hospital from May to August and then from September to December 2006. The criteria of the rational use of imipenem were obtained from a non-systematic revision of the literature. The collection of data on the general characteristics and clinical state of the patient, the infection and the established therapy was carried out in a previously tested instrument. Data was recorded, revised and analyzed in a database built with the software SPSS® for Windows® PC, version 10.0. The statistical analysis had a descriptive character: frequencies, mean, median and standard deviation. No differences were encountered in relation to the appropriate indication, consumption and clinical outcomes of patients. However, there was a reduction of 4 to 1 (75.0 percent) in the number of associations with spectrum superposition and an increase of 4 to 8 (50.0 percent) in the change of therapy. The restructuring of the antimicrobial audit system in the studied hospital did not reflect significantly the increase of the appropriate indication of imipenem. It contributed, however, to the reduction of the inappropriate associations of this antibiotic and to changes of therapy, without, however, compromising the quality of services rendered to patients.

Validation of criteria for nosocomial use of amikacin in Brazil with the Delphi technique

The Delphi technique has been used since the 1950s to collect the opinions of experts; to gauge their indications, and in some instances, to develop a consensus. This systematic collection and aggregation of informed judgments from a group of experts on specific questions or issues is a highly efficient and cost-effective means to establish guidelines and policies, when compared to other strategies, such as committee meetings or personal interviews. OBJECTIVE: Examine the content validation process of the proposed criteria of the American Society of Health System Pharmacists (ASHP) for amikacin use in hospital settings. MATERIAL AND METHODS: The Delphi technique was applied using the proposed ASHP criteria questionnaire containing 102 specific questions related to the nosocomial use of amikacin by individual patients. The questionnaire contained six groups of questions: 1) Identification and basic demographic data, 2) Relevant data for the use of amikacin, 3) Justification of its usage, 4) Critical parameters of amikacin use, 5) Complications, 6) Measurement of results. Eight hospital specialist medical doctors were selected, including five in the area of infectious diseases, one surgeon, one nephrologist and one in critical care medicine. The questionnaire was e-mailed to the doctors and they were asked for their opinion about the appropriateness of the questions. They were to say whether the general concept seemed totally or partially adequate to the proposed process, what grade (0 to 10) they would give to each section, and if there were any perceived deficiencies, they could add, omit or modify individual questions. A second questionnaire containing the questions for which there had been no consensus based on the answers to the previous one was re-sent to the participants for consolidation. RESULTS: Feedback revealed an agreement of 75 percent concerning the utility and appropriateness of sections 1 and 2. The section about the justification of amikacin usage was agreed on by 50 percent. There was a total agreement of 62 percent for the critical parameters of amikacin use, and a partial agreement of 37 percent. The complication of usage of the questionnaire was agreed upon by 50 percent of the participants, and positive measurement of the results was totally agreed on by 62 percent, and partially by 37 percent. The overall score for the questionnaire was 8.77 ± 0.25. CONCLUSION: The usage criteria for amikacin recommended by ASHP were validated by the Delphi technique for utilization in Brazilian hospital settings. The Delphi technique applied to validate a questionnaire instrument for monitoring the correct use of a specific strategic antibiotic indicated for the treatment and prophylaxis of serious antibiotic-resistant Gram-negative bacteria, proved to be a reliable and simple tool for designing guidelines and a consensus document for hospital use of antibiotics.