Impacto de un programa de optimización de uso de antimicrobianos en un hospital pediátrico de tercer nivel en Panamá

Abstract

Introducción: Los programas de optimización de uso de antimicrobianos (PROA) se enfocan en el uso apropiado de antimicrobianos para ofrecer mejores resultados clínicos y menores riesgos de eventos adversos. Objetivos: Comparar consumo y costos de antimicrobianos antes y después de instauración de un programa de regulación de antimicrobianos y describir la proporción de resistencia de bacterias prioritarias. Métodos: Estudio cuasi-experimental, retrospectivo y prospectivo, descriptivo y analítico, que comparó el consumo y costo de antimicrobianos en un período pre-intervención (2007-2010) y un período post-intervención (2011-2017). Se realizó análisis descriptivo de resistencias bacterianas prioritarias. Resultados: El consumo de gentamicina, vancomicina, meropenem, cefotaxima, ceftazidima e imipenem disminuyó significativamente en el período postintervención comparado con el período pre-intervención (p < 0,05), mientras que el consumo de amikacina, piperacilina/tazobactam, cefepime y levofloxacina en el período post-intervención mostró un aumento significativo. La reducción de costos no fue significativa para gentamicina, vancomicina, meropenem, cefotaxima, ceftazidima e imipenem. Para amikacina, cefepime, piperacilina/tazobactam y levofloxacina el aumento de costos no fue significativo. Los aislamientos de Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus y Enterococcus faecalis disminuyeron durante el período post-intervención. Conclusión: el PROA demostró disminución en consumo y costos de algunos antimicrobianos.

Antimicrobial Stewardship Programs in Latin America and the Caribbean: A Story of Perseverance, Challenges, and Goals

“…The results of this study, defined as the first AMS experience in the country, indicated significant changes in antibiotic consumption, with a decrease in vancomycin, gentamycin, meropenem, imipenem, and some other antibiotics, but there was an increase in amikacin, piperacillin/tazobactam, cefepime, and levofloxacin. [ 30 ]. Additional studies from Brazil and Colombia using ‘restrictive bundles’ for antimicrobials as part of their ASM strategies have also been published [ 26 , 31 ].…”

“…For the LAC region, there are different publications analyzing costs and the economic impact of implementing AMS strategies. Most of the publications focus on the impact of reducing antimicrobial consumption on hospital costs [ 24 , 30 , 32 , 39 , 40 ]. According to Fica et al [ 39 ], the long-term effects of ASP and its impact on cost savings are not usually reported.…”

“…A study presented previously by Magedanz et al also reported a 69% reduction in hospital antibiotic costs after the implementation of an ASP [ 32 ]. In a study conducted by Rojas-Bonilla et al [ 30 ] with ASM interventions based on antimicrobial restriction, they concluded that the reduction in costs was not significant for gentamicin, vancomycin, meropenem, cefotaxime, ceftazidime, or imipenem, with a non-significant increase in costs for amikacin, piperacillin/tazobactam, cefepime, and levofloxacin [ 30 ]. Other findings demonstrate that clinical and economic outcomes are significantly better for patients treated according to antibiotic flowcharts; flowcharts for common infections seem to be a very efficient way to implement prompt and appropriate empiric antibiotic therapy in some areas, like the emergency room [ 41 ].…”

“…The literature found for LAC demonstrates that there are diverse changes in cost savings based on the different AMS interventions implemented, but robust and systematic approaches to cost savings in healthcare settings related to the implementation of AMS strategies are difficult given the variability among healthcare systems, billing procedures, and, particularly, the lack of structured communication among healthcare staff and the administrative and financial decision-makers within institutions. The evidence presented for the economic impact of AMS has immense value for decision-makers in healthcare that can utilize these studies to support ASP and prioritize interventions for AMS specifically in LAC hospitals [ 24 , 30 , 32 , 39 , 40 ]. Social and cultural factors (such as collaboration between specialties and different levels of care and working conditions) have been shown to be important behavioral determinants in healthcare professionals for following ASP interventions and might represent barriers to the implementation and success of AMS strategies in the LAC region, as commented by Favre et al [ 10 ].…”