RESUMO
El uso inadecuado de antibióticos involucra al prescriptor: sobre él influyen diversos factores académicos, sociales, ambientales, económicos, culturales y políticos; ocurre principalmente en el primer nivel de atención en el área pediátrica.Objetivos: Determinar conocimientos, actitudes y prácticas en la prescripción de antibióticos en infecciones prevalentes respiratorias y diarreicas en menores de 5 años. Metodología: Estudio transversal realizado en la región amazónica Morona Santiago, Área de Salud 3, Ecuador. Se valoraron conocimientos y actitudes al universo de 16 prescriptores, mediante casos clínicos elaborados por Herranz, adaptados al medio, relacionados a rinofaringitis, otitis media aguda, neumonía, bronquiolitis, gastroenteritis; para las prácticas se revisaron el universo de 225 historias clínicas de niños diagnosticados en los dos meses previos. La prescripción se valoró mediante los protocolos actualizados de la Organización Panamericana de la Salud. Se tabuló mediante SPSS y se utilizó estadística descriptiva como promedios, frecuencias y porcentajes.Resultados: Existió dificultad en la prescripción de otitis media aguda, neumonía, gastroenteritis bacteriana, especialmente en dosis y duración. La prescripción inadecuada en rinofaringitis fue similar tanto en la teoría como en la práctica (18,7%). El caso de rinosinusitis fue poco diagnosticado (31,3%); en la práctica no se mencionó algún caso. Frente al cuadro hipotético que superpone datos para neumonía como bronquiolitis, el 75% lo diagnosticó como neumonía; en la práctica ningún diagnóstico indicó bronquiolitis. Conclusiones: Existe dificultad en la prescripción de antibióticos siendo necesaria la implementación de un programa integral de educación continua sobre Uso Racional de Antibióticos que considere factores asociados tales como: contexto laboral, ecosistema, nivel socio-económico y cultural de sus pacientes, rol del sistema de salud, y organización política entre otros.
Inappropriate use of antibiotics involves prescribers and occurs mainly in the primary health care units. Academic, social, environmental, economic, cultural and political factors are linked to this health problem. Objectives: To determine knowledge, attitudes and practices in antibiotic prescription in respiratory and diarrheal prevalent infectious affecting children under 5 years.Methods: Cross-sectional study conducted in Morona Santiago province, Health Area: 3, Ecuador.Knowledge and attitudes to the world of prescri-berswere assessed using hypothetical clinical cases made by Herranz, adapted to the environment, about rinopharyngitis, acute otitis media, pneumonia, bronchiolitis, gastroenteritis. The practice was evaluated through the clinical histories of 225 children diagnosed two months before. The pres-cription was analyzed according to Pan American Health Organization protocols. It was tabulated using SPSS and analyzed using descriptive statistics as means, frequencies and percentages. Results: There was difficulty in the acute otitis media, pneumonia, bacterial gastroenteritis prescription; especially in doses and treatment duration. Inappropriate prescription in nasopharyngitis was similar in both theory and practice (18.7%). The rhinosinusitis was diagnosed in the 31.3%; in the practice none case was mentioned. In the hypothetical cli-nical case about low respiratory infection, 75% was diagnosed like pneumonia; in the practice none bronchiolitis case was diagnosed.Conclusions: There is difficulty in prescribing antibiotics. A comprehensive program of continuing education on rational use of antibiotics is being neces-sary. Analysis of the associated factors such as: the employment and ecosystem context, ecosystem, socio economic and cultural level of their patients, the role of health system, and political organization, should be considered.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Pediatria , Infecções Bacterianas , Antibacterianos , Infecções Respiratórias , Diarreia Infantil , Uso de Medicamentos , Medicamentos sob Prescrição , Prescrição InadequadaRESUMO
BACKGROUND AND AIMS: Neonatal infections caused by Extended-spectrum beta-lactamase (ESBL)-producing bacteria are associated with increased morbidity and mortality. No data are available on neonatal colonization with ESBL-producing bacteria in Ecuador. The aim of this study was to determine the proportion of intestinal colonization with ESBL-producing Enterobacteriaceae, their resistance pattern and risk factors of colonization in a neonatal intensive care unit in Ecuador. METHODS: During a three month period, stool specimens were collected every two weeks from hospitalized neonates. Species identification and susceptibility testing were performed with Vitek2, epidemiologic typing with automated repetitive PCR. Associations between groups were analyzed using the Pearson X (2) test and Fisher exact test. A forward step logistic regression model identified significant predictors for colonization. RESULTS: Fifty-six percent of the neonates were colonized with ESBL-producing Enterobacteriaceae. Length of stay longer than 20 days and enteral feeding with a combination of breastfeeding and formula feeding were significantly associated with ESBL-colonization. The strains found were E. coli (EC, 89%) and K. pneumoniae (KP, 11%) and epidemiological typing divided these isolates in two major clusters. All EC and KP had bla CTX-M group 1 except for a unique EC isolate that had bla CTX-M group 9. Multi-locus sequence typing performed on the K. pneumoniae strains showed that the strains belonged to ST855 and ST897. The two detected STs belong to two different epidemic clonal complexes (CC), CC11 and CC14, which previously have been associated with dissemination of carbapenemases. None of the E. coli strains belonged to the epidemic ST 131 clone. CONCLUSIONS: More than half of the neonates were colonized with ESBL-producing Enterobacteriaceae where the main risk factor for colonization was length of hospital stay. Two of the isolated clones were epidemic and known to disseminate carbapenemases. The results underline the necessity for improved surveillance and infection control in this context.
