Pseudomonas aeruginosa in the ICU: prevalence, resistance profile, and antimicrobial consumption

Abstract INTRODUCTION: Pseudomonas aeruginosa is one of the main pathogens causing infection in intensive care units (ICUs) and usually presents antimicrobial resistance. METHODS: Data were obtained from ICUs between 2010 and 2013. RESULTS: P. aeruginosa had a prevalence of 14.5% of which 48.7% were multidrug resistant. We observed increasing resistance to carbapenems and polymyxin B and growing consumption of aminoglycosides, meropenem, ceftazidime, and polymyxin B. The regression impact between resistance and consumption was significant with respect to amikacin, imipenem, meropenem, and polymyxin B. CONCLUSIONS: Monitoring antimicrobial consumption and resistant microorganisms should be reinforced to combat antimicrobial- and multi-drug resistance.

Prescrição de antibióticos a crianças atendidas no inverno em Unidade de Saúde de município paulista / Prescription of antibiotics to children in winter at a basic health unit in the state of São Paulo, Brazil

Estudos de utilização de medicamentos podem contribuir para a antibioticoterapia racional, por revelarem perfis de utilização, possíveis distorções e necessidades de intervenção. O objetivo deste trabalho foi avaliar as características das prescrições médicas de antibióticos na terapêutica de crianças de 0 a 5 anos de idade de Unidade de Saúde de Santa Bárbara d’Oeste-SP, no inverno. O estudo de delineamento transversal foi conduzido entre julho e agosto de 2008. Das 262 prescrições emitidas no período, 173 (66%) apresentaram pelo menos um antibiótico. Entre estas, identificou-se a média de 2,9 medicamentos prescritos por receita, 93% sob denominação genérica e 96% constantes na Relação Municipal de Medicamentos Essenciais. A amidalite foi a causa mais frequente de indicação de antibióticos, seguida de otite e bronquite. O fármaco mais prescrito foi a amoxicilina, exceto para doenças de pele, feridas auriculares e gastroenterocolite. Em 25% das prescrições houve associação de antibióticos, sendo 81% amoxicilina associada à penicilina benzatina potássica. A amoxicilina foi prescrita em doses diárias acima do recomendado pelos Guideliness em 63,5% das prescrições e frequentemente em conjunto com o ambroxol. A alta prevalência do emprego conjunto de fármacos de mesma classe terapêutica e o elevado número de vezes em que houve sobredose nas prescrições pode ser prejudicial à saúde das crianças.

Studies on medication use can contribute to rational antibiotic therapy, revealing use patterns, possible distortions and the need for interventions. The aim of the present study was to evaluate the use of antibiotic therapy for children aged 0 to five years at a basic health unit in the city of Santa Barbara d’Oeste (state of São Paulo, Brazil) based on prescriptions made in winter. A cross-sectional study was conducted between July and August 2008. From a total of 262 prescriptions issued in the period, 173 (66%) had at least one prescription of antibiotics. The mean number of drugs prescribed per prescription was 2.9. A total of 93% of the drugs were prescribed under the generic denomination and 96% were included on the Municipal Essential Drugs List. Tonsillitis was the most frequent indication for antibiotics, followed by otitis and bronchitis. The most prescribed drug was amoxicillin, except for skin diseases, ear injuries and gastroenterocolitis. Antibiotics were prescribed in association in 25% of the prescriptions and amoxicillin was associated with potassium benzathine penicillin in 81% of such cases. Amoxicillin was prescribed in excessive doses in 63.5% of prescriptions and often together with the ambroxol. The high frequency of joint drug prescriptions from the same therapeutic class and the large number of times in which an excessive dose was prescribed constitute a risk to child health.