Laboratory of Molecular Microbiology, Universidade Federal de Uberlândia, Uberlândia, Brazil.
Departamento de Ciências da Saúde, Universidade Federal Rural do Semi-Árido, Mossoró, Brazil.
J Med Microbiol. 2024 Oct;73(10). doi: 10.1099/jmm.0.001908.
Efforts to understand the burden of antibiotic use in low- and middle-income countries such as Brazil are essential for developing strategies that are effective and appropriate in the context of endemic multidrug-resistant organisms. This study aims to determine antimicrobial-prescribing practices among patients hospitalized in intensive care units (ICUs) for adults in Brazil. A 1-day point prevalence multicentre survey was conducted in 58 adult ICUs across the five regions of Brazil. The institutions were categorized according to their type and size. Detailed antimicrobial prescription data were prospectively provided to all patients hospitalized on the day of data collection. A total of 620 patients were included in the study, of whom 63.9% were receiving at least one antimicrobial. Of these, 34.6% were treated for an infection, but only 39.9% of the cases were based on microbiological criteria. Empirical treatment was applied to 72.3% of the patients. Significant differences in antibiotic usage were observed across the different hospitals included in the study. Overall, treatment was most commonly directed towards pneumonia (51.8%) and bloodstream infections (29.6%). Glycopeptides (19.4%) and carbapenems (18.5%) were the most prescribed in teaching hospitals, while in non-teaching hospitals, carbapenems (17.8%) and broad-spectrum cephalosporins (16.8%) were most frequently used. Our study reveals alarming data on antibiotic use in adult ICUs in Brazil, with high frequencies of severe healthcare-associated infections acquired in these units, where patients are frequently subjected to empirical treatment.
努力了解巴西等中低收入国家抗生素使用的负担对于制定在地方性多药耐药菌流行环境下有效和适当的策略至关重要。本研究旨在确定巴西成人重症监护病房（ICU）住院患者的抗菌药物处方实践。在巴西五个地区的 58 家成人 ICU 中进行了为期一天的点患病率多中心调查。这些机构根据其类型和规模进行了分类。详细的抗菌药物处方数据前瞻性地提供给了在数据收集当天住院的所有患者。共有 620 名患者纳入研究，其中 63.9%至少接受一种抗菌药物治疗。其中，34.6%是针对感染进行治疗的，但只有 39.9%的病例是基于微生物学标准。对 72.3%的患者进行了经验性治疗。在所研究的不同医院中，抗生素的使用存在显著差异。总体而言，治疗最常用于肺炎（51.8%）和血流感染（29.6%）。糖肽（19.4%）和碳青霉烯类（18.5%）在教学医院中使用最多，而在非教学医院中，碳青霉烯类（17.8%）和广谱头孢菌素类（16.8%）使用最频繁。我们的研究揭示了巴西成人 ICU 中抗生素使用的令人震惊的数据，这些单位中经常发生严重的医疗保健相关感染，患者经常接受经验性治疗。
