RESUMO
A controlled intervention study was performed in a paediatric hospital in Russia to improve antibiotic use and to see whether improvements persisted. During October-December 2002, clinical and microbiological data, antibiotic use, costs and outcome were recorded at two wards for gastrointestinal infections (GIIs) and two wards for respiratory tract infections (RTIs). Guidelines for diagnosis and treatment of infections were developed and implemented at one ward for GIIs and one ward for RTIs in 2003. The other two wards served as controls. The same data were recorded during the same 3-month periods in 2003 and 2004. At the intervention ward, the percentage of patients with GII who received antibiotics decreased from 94% in 2002 to 41% in 2003, but increased to 73% in 2004. In RTI patients these percentages were 90% in 2002, 53% in 2003 and 83% in 2004. The proportions of patients who received antibiotics in 2004 were still lower than in 2002: risk difference (RD)=0.217 (P=0.001) in GIIs and RD=0.073 (P=0.013) in RTIs. From 2002 to 2004 there was a decrease in cephalosporin use (P=0.021) and an increase in penicillin use (P=0.032) in pneumonia. There was no difference in mortality, duration of fever or duration of hospital stay between the intervention and control wards. Antibiotic use could be halved without compromising the quality of patient care, but 1 year after the intervention the use of antibiotics approached pre-intervention levels. Strategies to sustain the effect of interventions are needed.
Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Gastroenterite/tratamento farmacológico , Infecções Respiratórias/tratamento farmacológico , Adolescente , Infecções Bacterianas/mortalidade , Criança , Pré-Escolar , Gastroenterite/microbiologia , Fidelidade a Diretrizes , Hospitais , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Guias de Prática Clínica como Assunto , Infecções Respiratórias/microbiologia , Federação Russa , Resultado do TratamentoRESUMO
BACKGROUND: An increased incidence of communicable diseases, especially HIV-infection, has since the mid 1990ies been observed in Northwest Russia and the Baltic countries. Injecting drug use has until now been the most important factor in the spread of HIV in the area. MATERIAL AND METHODS: This paper is based on surveillance data published by EuroHIV, Epi North and the Norwegian notification system for communicable diseases, and on personal experience. We present an overview of the epidemiological HIV situation in Northwest Russia and the countries of the Baltic Sea area, and the effect this has on the HIV-epidemic in Norway. RESULTS AND INTERPRETATION: In Northwest Russia and the Baltic countries, a sharp rise of newly diagnosed HIV-cases started in 1998 and a peak was observed in 2001. The reduction of reported cases observed during the last few years is mainly caused by fewer newly diagnosed HIV-cases in intravenous drug users. An increasing proportion of the newly diagnosed cases of HIV occur among women. It is uncertain if this reflects sexual spread to drug users' partners, or if it is the beginning of a heterosexual epidemic in the general population. Men who have sex with men do currently not account for a large proportion of total cases in Northwest Russia and the Baltic countries, but stigmatisation of this group may cause underreporting of this transmission route. The epidemiological situation in the neighbouring countries has had little effect on the HIV epidemic in Norway. This is probably because HIV in Northwest Russia until now has been limited to social groups that have little contact with Norway or Norwegians visiting Russia.