Antimicrobial stewardship through telemedicine and its impact on multi-drug resistance.

INTRODUCTION: Telemedicine technologies are increasingly being incorporated into infectious disease practice. We aimed to demonstrate the impact of antimicrobial stewardship through telemedicine on bacterial resistance rates. METHODS: We conducted a quasi-experimental study in a 220-bed hospital in southern Brazil. An antimicrobial stewardship program incorporating the use of telemedicine was implemented. Resistance and antimicrobial consumption rates were determined and analysed using a segmented regression model. RESULTS: After the intervention, the rate of appropriate antimicrobial prescription increased from 51.4% at baseline to 81.4%. Significant reductions in the consumption of fluoroquinolones (level change, ß = -0.80; P < 0.01; trend change, ß = -0.01; P = 0.98), first-generation cephalosporins (level change, ß = -0.91; P < 0.01; trend change, ß = +0.01; P = 0.96), vancomycin (level change, ß = -0.47; P = 0.04; trend change, ß = +0.17; P = 0.66) and polymyxins (level change, ß = -0.15; P = 0.56; trend change, ß = -1.75; P < 0.01) were identified. There was an increase in the consumption of amoxicillin + clavulanate (level change, ß = +0.84; P < 0.01; trend change, ß = +0.14; P = 0.41) and cefuroxime (level change, ß = +0.21; P = 0.17; trend change, ß = +0.66; P = 0.02). A significant decrease in the rate of carbapenem-resistant Acinetobacter spp. isolation (level change, ß = +0.66; P = 0.01; trend change, ß = -1.26; P < 0.01) was observed. CONCLUSIONS: Telemedicine, which provides a tool for decision support and immediate access to experienced specialists, can promote better antibiotic selection and reductions in bacterial resistance.

Compreensão da vivência da família frente à hospitalização, morte encefálica e entrevista para doação de órgãos / Understanding the experience of family facing hospitalization, brain death, and donation interview

O presente estudo buscou compreender a vivência da família no processo de hospitalização do familiar, morte encefálica e entrevista para a doação de órgãos. Trata-se de uma pesquisa exploratória, descritiva, de natureza qualitativa, com abordagem fenomenológica. Os sujeitos foram 15 famílias de pacientes que tiveram lesão neurológica grave e aguda, evoluíram com diagnóstico de morte encefálica, cujas famílias foram entrevistadas para a doação de órgãos e não a autorizaram. Após análise do material empírico, surgiram duas unidades de significados: (1) Hospitalização; e (2) Entrevista para Decisão sobre Doação. Essas unidades de significados são representadas pelo "impacto da notícia"; "barreiras na comunicação"; "relação com a equipe"; "informação da morte encefálica"; "dor da perda"; "informação sobre doação" e "tomada de decisão". A trajetória vivenciada pelas famílias é difícil e se faz necessário repensar o atendimento a essas pessoas pelos profissionais de saúde durante esse processo. O tempo entre a comunicação da morte e a informação sobre doação de órgãos é importante para que a família possa organizar seus pensamentos e tomar a melhor decisão. O estudo mostra que esse tempo não foi respeitado.

This study aimed to understand the experience of families in the process ofhospitalization, brain death and interview for organ donation. It is an exploratory, descriptive, qualitativeresearch ofphenomenological approach. The subjects were 15 families of patients who had severe and acute brain injury thatevolved to a brain deathdiagnosis, whose families were interviewed for organ donation but didnot authorizeit.After analysis of the empirical material, two units of meaningarose: (1) Hospitalization; and (2) Interview for Decisionon Donation. These units of meaning are represented by "impact of the news"; "barriers to communication"; "relationship with the team"; "reportingthe brain death"; "pain for theloss"; "informingabout donation" and "decision-making".The path walked by the families is difficult and makes it necessary to rethink the care provided tothese people by health professionals throughout theprocess. The time between the reportof the death and the provision of information about organ donation is important for the family to organize itsthoughts and make the best decision. The study shows that this time has not beenrespected.