Impacto da infusão prolongada de antimicrobianos beta-lactamicos na morbidade e mortalidade de pacientes criticos
Data
2014
Autores
Macedo, Rodrigo Spineli 
Orientadores
Furtado, Guilherme Henrique Campos
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Infecções por microorganismos multirresistentes têm se transformado, nos último anos, num grave problema de saúde pública. A escassez de lançamento de novos agentes efetivos contra estes patógenos leva a necessidade de otimização do uso, através de parâmetros farmacodinâmicos, dos antimicrobianos já existentes e a infusão prolongada de beta-lactâmicos surge como uma alternativa viável para este problema. Objetivo: O objetivo do presente estudo foi analisar o impacto da implementação de um protocolo de infusão prolongada de beta-lactâmicos em pacientes críticos admitidos em duas unidades de terapia intensiva (UTI) de um hospital-escola. Materiais e Métodos: Um estudo quasi-experimental (do tipo <antes e depois=) foi conduzido no período entre maio de 2011 a abril de 2013 com pacientes internados em duas UTIs médico-cirúrgicas. Comparamos os desfechos clínicos dos pacientes que receberam cinco antibióticos beta-lactâmicos em infusão intermitente (primeiro período) versus aqueles que receberam os mesmo antibióticos em infusão prolongada (segundo período). Mortalidade em 14 dias, 28 dias, em UTI e hospitalar foram analisadas junto com desfechos secundários, como duração de uso de drogas vasoativas, ventilação mecânica, tempo de pirexia e leucocitose. Preditores de mortalidade hospitalar e em 28 dias foram avaliados. Resultados: 106 pacientes foram incluídos no estudo (52 pacientes no grupo da infusão intermitente e 54 pacientes no grupo da infusão prolongada). Em relação aos desfechos clínicos, não houve diferença significativa na mortalidade em 14 dias (12,2% vs. 8,3%, p=0.76), em 28 dias (4,1% vs. 10,41%; p=0,41), em UTI (30,6% vs. 25%, p=0,69) e hospitalar (40,8% vs. 39,6%, p=0,96). Entre os desfechos secundários, duração da ventilação mecânica (seis dias vs. dez dias; p=.0099) e duração da leucocitose (cinco dias vs. oito dias; p=.0009) foram maiores no segundo período. Duração do suporte inotrópico (OR 1.12; 95% CI 1.01-1.24 p=.034) e IRA (OR 10.17; 95% CI 1,16-89,03 p=.036) foram preditores de mortalidade hospitalar, enquanto que IRA (OR 24,38; 95% CI 2,79-212,74 p=0,0039) e escore SOFA (OR 1,42; 95% CI 1,11-1,81 p=0,0058) foram preditores de mortalidade em 28 dias. Conclusão: Nosso estudo não mostrou diferenças entre as duas modalidade de infusão de beta-lactâmicos entre pacientes críticos. Insuficiência renal aguda, SOFA e duração de suporte inotrópico foram preditores de mortalidade.
In the last few years, infections caused by multidrug-resistant bacteria have been transformed in a serious public health problem. Shortage of new and effective antimicrobial agents against these pathogens leads to the need to optimize the use of older agents through pharmacodynamics that has emerged as a viable alternative for this problem. Objective: The aim of this study was to analyze the impact of the implementation of a protocol of extended infusion of beta-lactams in critically ill patients admitted to two medical-surgical intensive care units (ICUs) of a teaching hospital. Methods: A quasi-experimental ("before and after") study was conducted from May 2011 to April 2013. We compared the clinical outcomes of the patients who received five different beta-lactams antibiotics in intermittent infusion (first period) versus those patients who received the same beta-lactams in extended infusion (second period). In- hospital mortality and ICU mortality were analyzed along with secondary outcomes such as duration of vasopressor drug therapy, mechanical ventilation, duration of pyrexia and leukocytosis. Predictors of all cause in-hospital and 28-day mortality were assessed. Results: A total of 106 patients were included (52 patients in the intermittent infusion group and 54 patients in the extended infusion group). Regarding clinical outcomes, there was no significant difference in 14-day (12,2% vs. 8,3%, p=0.76), 28-day (4,1% vs.10,41%; p=0,41), ICU- (30,6% vs. 25%, p=0,69) and all cause in-hospital mortality (40,8% vs. 39,6%, p=0,96). Among secondary outcomes, duration of mechanical ventilation (6 days vs. 10 days; p=.0099) and duration of leukocytosis (5 days vs. 8 days; p=.0099) were greater over the second period. Duration of vasopressor therapy (OR 1.12; 95% CI 1.01 to 1.24 p=.034) and acute renal failure (OR 10.17; 95% CI 1,16 to 89,03 p=.036) were predictors of all cause inhospital mortality, whereas acute renal failure (OR 24,38; 95% CI 2,79 to 212,74 p=0,0039 ) and SOFA score (OR 1,42; 95% CI 1,11 to 1,81 p=0,0058) were predictors for 28-day mortality. Conclusion: Our study showed no differences between the two kinds of beta-lactams infusion among critically ill patients. Acute renal failure, SOFA score and duration of vasopressor therapy were potential predictors of mortality.
In the last few years, infections caused by multidrug-resistant bacteria have been transformed in a serious public health problem. Shortage of new and effective antimicrobial agents against these pathogens leads to the need to optimize the use of older agents through pharmacodynamics that has emerged as a viable alternative for this problem. Objective: The aim of this study was to analyze the impact of the implementation of a protocol of extended infusion of beta-lactams in critically ill patients admitted to two medical-surgical intensive care units (ICUs) of a teaching hospital. Methods: A quasi-experimental ("before and after") study was conducted from May 2011 to April 2013. We compared the clinical outcomes of the patients who received five different beta-lactams antibiotics in intermittent infusion (first period) versus those patients who received the same beta-lactams in extended infusion (second period). In- hospital mortality and ICU mortality were analyzed along with secondary outcomes such as duration of vasopressor drug therapy, mechanical ventilation, duration of pyrexia and leukocytosis. Predictors of all cause in-hospital and 28-day mortality were assessed. Results: A total of 106 patients were included (52 patients in the intermittent infusion group and 54 patients in the extended infusion group). Regarding clinical outcomes, there was no significant difference in 14-day (12,2% vs. 8,3%, p=0.76), 28-day (4,1% vs.10,41%; p=0,41), ICU- (30,6% vs. 25%, p=0,69) and all cause in-hospital mortality (40,8% vs. 39,6%, p=0,96). Among secondary outcomes, duration of mechanical ventilation (6 days vs. 10 days; p=.0099) and duration of leukocytosis (5 days vs. 8 days; p=.0099) were greater over the second period. Duration of vasopressor therapy (OR 1.12; 95% CI 1.01 to 1.24 p=.034) and acute renal failure (OR 10.17; 95% CI 1,16 to 89,03 p=.036) were predictors of all cause inhospital mortality, whereas acute renal failure (OR 24,38; 95% CI 2,79 to 212,74 p=0,0039 ) and SOFA score (OR 1,42; 95% CI 1,11 to 1,81 p=0,0058) were predictors for 28-day mortality. Conclusion: Our study showed no differences between the two kinds of beta-lactams infusion among critically ill patients. Acute renal failure, SOFA score and duration of vasopressor therapy were potential predictors of mortality.
Descrição
Citação
MACEDO, Rodrigo Spineli. Impacto da infusão prolongada de antimicrobianos betalactâmicos na morbidade e mortalidade de pacientes críticos. 2014. 76 f. Dissertação (Mestrado em Infectologia) – Escola Paulista de Medicina, Universidade Federal de São Paulo, 2014.