Consenso latinoamericano sobre la importancia de un sistema de gestión de datos microbiológicos para apoyar el programa de optimización de uso de antimicrobianos (PROA): Recomendaciones basadas en la evidencia. Parte 1 / Latin American consensus on the importance of a microbiological data management system to support antimicrobial use optimization program (PROA): Evidence-based recommendations. Part 1

La resistencia antimicrobiana es una amenaza para los logros de la medicina moderna y una de las medidas más efectivas para contrarrestarla son los programas de optimización del uso de antimicrobianos (PROA), en el cual el laboratorio de microbiología es uno de los principales componentes. La aplicación efectiva de tecnología de la información en los procesos es fundamental, pero existe poca información en Latinoamérica sobre el desarrollo y la articulación de las herramientas tecnológicas para apoyar los PROA. Este consenso hace recomendaciones sobre la gestión de los datos microbiológicos para la toma de decisiones. En la Parte I, se presentan las recomendaciones en cuanto al uso de un sistema informatizado de gestión de datos microbiológicos en la práctica clínica, los requerimientos de datos y de reporte en el laboratorio de microbiología, y los contenidos del sistema de gestión de calidad avanzado en el laboratorio. En la Parte II, se discuten los requerimientos de información para la gestión de PROA en estadios intermedios, iniciales y avanzados por el laboratorio y la farmacia; así como la integración del equipo de PROA con el Comité de Prevención y Control de Infecciones y la información para la gestión de PROA a nivel gerencial.

Antimicrobial resistance is a threat to the achievements of modern medicine and one of the most effective measures to counteract it is antimicrobial use optimization programs (AMS), in which the microbiology laboratory is one of the main components. The effective application of information technology in the processes is fundamental, but there is little information in Latin America on the development and articulation of technological tools to support AMSs. This consensus makes recommendations on the management of microbiological data for decision making. In Part I, recommendations on the use of a computerized microbiological data management system in clinical practice, data and reporting requirements in the microbiology laboratory, as well as the contents of the advanced quality management system in the laboratory are presented. In Part II, the information requirements for AMS management in intermediate, initial, and advanced stages by the laboratory and pharmacy are discussed; as well as the integration of the AMS team with the Infection Prevention and Control Committee and the information for AMS management at the management level.

Discussion on the rationality of clinical application of prolonging antibiotic infusion time / 中国小儿急救医学

The rapidly growing emergence of drug resistant bacteria has become one of the most important public health concerns.However, the development of new drugs is of more difficulties.Extended infusion or prolonged infusion of antibiotics is a significant way of antimicrobial stewardship programs, which has been proven beneficial to better pharmacokinetic/pharmacodynamic targets attainment and improved clinical outcomes.This review discussed the rationality of prolonging the infusion time of commonly used antibiotics in PICU.

The Increasing Interest in Antibiotic Stewardship Programs

Background:The inappropriate use of antibiotics leads to many adverse effects and also leads to bacterial resistance. A hospital-based program, commonly referred to as antibiotic stewardship programs, is usedto improve the usage of antibiotics. This study aims to explore the increasing interest of the public in antibiotic stewardship programs by using data from Google Trends and Twitter.Methodology:A search trends feature that shows how frequently a given search term is entered into Google’s search engine (Google Trends) and a social network site (Twitter) were used.Results:The public and the health care professionals are now more interested in antibiotic use and antibiotic resistance due to the development of more severe infections that were caused by bacteria resisted to many antibiotics which lead to high morbidity and mortality rates.Conclusion:There is a high prevalence of infections caused by multi-drug resistant organism that could lead to more mortality and morbidity rates, as a result the interest in antimicrobial stewardship programs in internet is increased. So it is important to increase the knowledge of health care professionals regarding the appropriate antibiotic use and to encourage them tochange their unsuitable prescribing patterns

Interacciones evolutivas como un posible mecanismo de interacción medicamentosa: una aproximación para el control de la resistencia bacteriana / Evolutionary interactions as a possible mechanism of drug interactions: an approach to the control of antibiotic-resistant bacteria

Resumen En el siglo XXI, la humanidad se encuentra frente a una era post-antibiótica, en la cual es común la aparición de infecciones con una menor o nula alternativa terapéutica. En este contexto, se hace indispensable implementar medidas que optimicen el arsenal terapéutico disponible, generando nuevas estrategias para contrarrestar la creciente resistencia bacteriana y la era post-antibiótica. Las interacciones evolutivas plantean que el desarrollo de susceptibilidad o resistencia de un microorganismo a un antimicrobiano tendrá un efecto inverso (susceptibilidad colateral) o similar (resistencia cruzada) en un segundo antimicrobiano incorporado en este sistema. Las interacciones evolutivas se plantean como un nuevo mecanismo de interacción medicamentosa, al tiempo que se identifica a la susceptibilidad colateral como una estrategia terapéutica para combatir la resistencia bacteriana, que se podría integrar y evaluar en un futuro como una nueva estrategia en los programas de gerenciamiento de antimicrobianos.

In the 21st century, the world is facing a post-antibiotic era, in which the appearance of infections with a minor or no therapeutic alternative is common. In this context, it is essential to implement measures that optimize the available therapeutic tool, thus generating new strategies that strengthen the fight against growing bacterial resistance. The evolutionary interactions suggest that the development of sensitivity or resistance of a microorganism to an antimicrobial will have an inverse effect (collateral sensitivity) or similar (cross resistance) in a second antimicrobial that is involved in this system. The evolutionary interactions are considered as a new mechanism of drug interaction, and additional, it establishes the collateral sensitivity as a therapeutic strategy to combat bacterial resistance, which could be integrated and evaluated in the future as a new strategy in the antimicrobial stewardship programs.

Implementación de un programa de control de antibióticos a nivel hospitalario: efecto económico / Implementation of an antibiotic stewardship program at hospital and its economic impact

Introducción: la implementación de programas de control de antibióticos (PCA) ha demostrado ser útil para controlar la resistencia microbiana y, además de otros beneficios, tiene un considerable impacto económico en la gestión sanitaria. El objetivo de esta investigación fue describir el efecto económico de un PCA. Métodos: se realizó un estudio de intervención en el Hospital Joaquín Albarrán entre mayo de 2008 y diciembre de 2011. Se calculó el gasto neto por uso de antimicrobianos (según familia y fármacos seleccionados) y la media mensual para los periodos anuales. Para explorar los cambios en gastos netos se realizó una regresión simple. Resultados: los gastos fueron de 3 763 903 CUP, y a partir de agosto de 2009 y hasta diciembre de 2011 (media 70 267,6 CUP) se observó una disminución de los gastos medios mensuales en un 40 por ciento (- 46 215,6 CUP mensuales), así como el descenso significativo en gastos totales y medios en el periodo de estudio (p < 0,001). Las cefalosporinas y las fluoroquinolonas aportaron la mayor proporción de gastos por uso de antimicrobianos (52,5 por ciento, y 32,8 por ciento respectivamente). Además, se observó un descenso significativo en las tasas de infección nosocomial (p < 0,001), pero no hubo modificaciones destacables en la tasa de mortalidad. Conclusión: la implementación de un PCA a nivel hospitalario influyó positivamente puesto que redujo los costos por uso de antimicrobianos. Se recomienda la aplicación de programas similares en las instituciones hospitalarias, utilizando estrategias individualizadoras según las características de cada institución.

Introduction: the implementation of antibiotic stewardship programs has proved to be useful to monitor the microbial resistance and, in addition to other advantages, it has considerable economic impact on the health management. The objective of this research work was to describe the economic impact of an antibiotic stewardship program. Methods: an intervention study was conducted in Joaquin Albarran hospital from May 2008 to December 2011. The net cost of the use of antimicrobials (by selected family and drugs) and the monthly mean for annual periods were estimated. A simple regression method was used to explore the changes in net costs. Results: the costs were 3 763 903 Cuban pesos, and from August 2009 to December 2011 (mean 70 267.6 Cuban pesos) there was a decline in monthly mean costs by 40 percent (- 46 215.6 Cuban pesos monthly) and significant reduction in total and average costs in the study period (p < 0.001). Cephalosporins and fluoroquinolones accounted for the highest proportion of costs due to the use of antimicrobials (52.5 percent and 32.8 percent, respectively. Additionally, there was significant decrease in the nosocomial infection rates (p < 0.001), but changes in the mortality rates were not remarkable. The implementation of an antibiotic stewardship program at hospital had a positive effect since it reduced the costs of the use of antimicrobials. The implementation of similar programs is recommended in hospitals, using customized strategies pursuant to the characteristics of each institution.

Política de antimicrobianos do Hospital de Clínicas de Porto Alegre: 2010 Comissão de Controle de Infecção Hospitalar / Antimicrobial stewardship program Hospital de Clínicas de Porto Alegre: 2010 Infection Control Committee

Programas de controle de antimicrobianos (PCAs) têm o objetivo de promover o uso racional de antibióticos. O uso racional de antimicrobianos melhora a eficácia do tratamento, reduz os custos relacionados aos medicamentos, minimiza eventos adversos, e reduz o potencial surgimento de resistência bacteriana. A estrutura destes PCAs foi publicada pela Sociedade Americana de Doenças Infecciosas. Uma combinação de educação, formulários de restrição de prescrição, auditoria prospectiva em antimicrobianos, feedback ao corpo clínico, são formas de estabelecer um programa de sucesso. A adesão por parte dos médicos da instituição é fundamental para o bom andamento do programa. Os PCAs devem atingir a todos os médicos na instituição independentemente da função ou experiência do profissional. Para tanto, uma diretriz de uso de antimicrobianos deve ser criada para servir de embasamento para as condutas estabelecidas e os médicos devem ter acesso a estas diretrizes. Descreveremos, a seguir, a política de antimicrobianos do Hospital de Clínicas de Porto Alegre para o ano de 2010.

Antimicrobial stewardship programs (ASPs) promote the appropriate use of antimicrobials. The appropriate use of antimicrobials has the potential to improve efficacy, reduce treatment-related costs, minimize drug-related adverse events, and limit the potential for emergence of antimicrobial resistance. The structure for antimicrobial stewardship programs has been published by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. A combination of education, formulary restriction and pre-authorization, prospective audit with intervention and feedback are forms of establishing a successful program. Gaining physicians acceptance is crucial and ASPs must apply to all physicians irrespective of experience or function in the hospital. An evidence based antimicrobial guideline must be constructed with hospital leaders and accessed by all physicians to help to disseminated antimicrobial policies. We describe Hospital de Clínicas de Porto Alegre antibiotic policies for the year of 2010.