Perfil de utilização de antibióticos em pacientes submetidos ao transplante de células-tronco hematopoiéticas em um hospital de referência em oncologia
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Dec 19, 2024
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Resumo
Objetivo: Analisar o perfil de uso de antibióticos no Centro de Transplante de Medula Óssea do Instituto Nacional do Câncer (CEMO/INCA). Métodos: Trata-se de um estudo descritivo, longitudinal e retrospectivo, o qual avaliou o uso de antibióticos em pacientes internados no CEMO/INCA, no município do Rio de Janeiro-RJ, no período de 1º de janeiro de 2020 a 31 de dezembro de 2021. 101 pacientes foram incluídos no estudo com idade ≥ 18 anos. Foram coletados os dados sociodemográficos, o perfil clínico, consumo de antibióticos, esquema de antibioticoterapia e resultados microbiológicos. O consumo de antibióticos foi expresso como uma dose diária definida (DDD) por 100 leito por dias. Os dados obtidos foram analisados por estatística descritiva e qualitativa. Os resultados foram apresentados na forma de tabelas de frequência e gráficos com auxílio do programa Microsoft Excel 2013. Resultados: 14 medicamentos apresentaram consumo considerável, como o cefepime (1434,3 DDD/100 leito/dias) e meropeném (1350,7 DDD/100 leito/dias). O início do antibiótico foi com amplo espectro e foi possível observar a prática do descalonamento. Conclusão: O perfil de prescrição dos antibióticos apresenta-se dentro das diretrizes preconizadas, contribuindo para o uso racional de medicamentos e segurança do paciente, bem como para o manejo adequado das infecções.
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Como Citar
PereiraF. A. N., SousaJ. da S., MoraesS. V. de, BarbozaJ. R., & PantojaW. M. S. (2024). Perfil de utilização de antibióticos em pacientes submetidos ao transplante de células-tronco hematopoiéticas em um hospital de referência em oncologia. Revista Eletrônica Acervo Saúde, 24(12), e18456. https://doi.org/10.25248/reas.e18456.2024
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Referências
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22. MORAES RB, et al. Descalonamento, adequação antimicrobiana e positividade de culturas em pacientes sépticos: estudo observacional. Revista Brasileira de Terapia Intensiva, 2016; 28: 315-322.
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24. MONROE K, et al. Quality Initiative to Improve time to Antibiotics for Febrile Pediatric Patients with Potential Neutropenia. Pediatr Qual Saf. 2018; 3(4): 95.
25. OLIVEIRA AL. Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients, 2007; 39: 775–781.
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27. QUADRI F, et al. Antibacterial drug shortages from 2001 to 2013: implications for clinical practice. Clin Infect Dis, 2015; 60: 1737–1742.
28. RAE N, et al. Oral versus intravenous clarithromycin in moderate to severe community-acquired pneumonia: an observational study. Pneumonia. 2017; 9(1): 2.
29. RODRIGUES R, et al. Perfil de utilização de medicamentos anti-infecciosos sistêmicos em um hospital oncológico. Revista espaço para a saúde, 2014; 15: 42-52.
30. ROSA RG, GOLDANI LZ. Cohort study of the impact of time to antibiotic administration on mortality in patients with febrile neutropenia. Antimicrob Agents Chemother, 2014; 58(7): 3799-803.
31. SBTMO. Sociedade Brasileira de Transplante de Medula Óssea. Diretrizes da Sociedade Brasileira de Transplante de Medula Óssea. 2012. Disponível em: https://sbtmo.org.br/wp-content/uploads/2021/07/Diretrizes_da_Sociedade_Brasileira_de_Transplante_de_Medula_Ossea_2012_ISBN_978-85-88902-17-6.pdf. Acessado em: 25 de Agosto de 2024.
32. SNYDER M, et al. Early antimicrobial de-escalation and stewardship in adult hematopoietic stem cell transplantation recipients: retrospective review. Open Forum Infectious Diseases, 2017; 4: 226.
33. SÖZEN H, et al. Application of ATC/DDD methodology to eveluate of antibiotic use in a general hospital in Turkey. Annals of clinical microbiology and antimicrobials, 2013; 12: 1-6.
34. SPADÃO F, et al. Incidence of diarrhea by Clostridium difficile in hematologic patients and hematopoietic stem cell transplantation patients: risk factors for severe forms and death. Rev. Inst. Med. Trop. Sao Paulo, 2014; 56(4): 325-31.
35. VENTOLA CL. The antibiotic resistance crisis: part 1: causes and threats. Pharmacy and Therapeutics, 2015; 40: 277-83.
36. VINCENTE JL. Nosocomial infections in adult intensive-care units. The Lancet, 2003; 361: 2068-2077.
37. WINGARD JR, et al. Hematopoietic stem cell transplantation: an overview of infection risks and epidemiology. Infectious Disease Clinics, 2010; 24: 257-272.
38. ZHANG H, et al. Allogeneic peripheral blood stem cell and bone marrow transplantation for hematologic malignancies: Meta-analysis of randomized controlled trials. Leukemia Res, 2012; 36: 431-437.
2. ALISON G, et al. Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America, Clinical Infectious Diseases, 2011; 52(4): 56-93.
3. ANVISA. Agência Nacional de Vigilância Sanitária. Diretriz Nacional para Elaboração de Programa de Gerenciamento de Antimicrobianos em Serviços de Saúde da Anvisa. Disponível em: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/publicacoes/DiretrizGerenciamentoAntimicrobianosANVISA2023FINAL.pdf. Acessado em: 03 de setembro de 2024.
4. BAZINET A, POPRADI G. A general practitioner's guide to hematopoietic stem-cell transplantation. Current oncology, 2019; 26: 187-191.
5. BRASIL. Instituto Nacional de Câncer - INCA. Contents about hematopoietic stem cell transplantation. Disponível em: bvsms.saude.gov.br/bvs/publicacoes/inca/topicos_transplantes.pdf. Acessado em: 25 de agosto de 2024.
6. CANNON JP, et al. The risk of seizures among the carbapenems: a meta-analysis Journal of Antimicrobial Chemotherapy, 2014; 69(8): 2043-2055.
7. CASTAGNOLA E, et al. A prospective study on the epidemiology of febrile episodes during chemotherapy-induced neutropenia in children with cancer or after hemopoietic stem cell transplantation. Clin. Infect. Dis. 2007; 45: 1296–1304.
8. CECINATI V, et al. Antibiotic prophylaxis in children with cancer or who have undergone hematopoietic cell transplantation. Eur. J. Clin. Microbiol. Infect. Dis. 2014; 33: 1–6.
9. CHO SY, et al. Cytomegalovirus Infections after Hematopoietic Stem Cell Transplantation: Current Status and Future Immunotherapy. Int J Mol Sci, 2019; 20: 2666.
10. COPELAN EA, et al. Allogeneic hematopoietic cell transplantation; the current renaissance. Blood Reviews 2019; 34: 34-44.
11. FERREIRA AM, et al. Epidemiology, risk factors and outcomes of multi-drug-resistant bloodstream infections in haematopoietic stem cell transplant recipients: importance of previous gut colonization. Journal of Hospital Infection, 2018; 100: 83-91.
12. FREIFELD AG, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis, 2011; 52: 56–93.
13. GOMES MJV, REIS AMM. Ciências Farmacêuticas: uma abordagem em farmácia hospitalar. São Paulo: Atheneu, 2001.
14. GUSTINETTI G, et al. De-escalation and discontinuation of empirical antibiotic treatment in a cohort of allogeneic hematopoietic stem cell transplantation recipients during the pre-engraftment period. Biology of Blood and Marrow Transplantation, 2018; 24(8): 1721-1726.
15. IMATAKI O, et al. Coincidental outbreak of methicillin‐resistant Staphylococcus aureus in a hematopoietic stem cell transplantation unit. American journal of hematology, 2006; 81: 664-669.
16. JANTARATHANEEWAT, K, et al. Pharmacist-driven antibiotic stewardship program in febrile neutropenic patients: a single site prospective study in Thailand. Antibiotics, 2021; 10(4): 456.
17. KLASTERSKY J, et al. Management of febrile neutropaenia: ESMO Clinical Practice Guidelines. Annals of oncolog : official journal of the European Society for Medical Oncology, 2016; 27: 111–118.
18. LEHRNBECHER, T, et al. Guideline for the management of fever and neutropenia in children with cancer and hematopoietic stem-cell transplantation recipients: 2017 update. American Society of Clinical Oncology, 2017. 35: 2082-2094.
19. MIMURA W, et al. Antimicrobial utilization and antimicrobial resistance in patients with haematological malignancies in Japan: a multi-centre cross-sectional study. Annals of clinical microbiology and antimicrobials, 2020; 19: 1-8.
20. MISCH EA, ANDES DR. Bacterial Infections in the Stem Cell Transplant Recipient and Hematologic Malignancy Patient. Infect Dis Clin North Am, 2019; 33: 399-445.
21. MOHAMMADZADEH M, et al. Drug utilization evaluation of agents administered for prevention and treatment of cancer-related infections. Journal of Pharmaceutical Care, 2021; 119-128.
22. MORAES RB, et al. Descalonamento, adequação antimicrobiana e positividade de culturas em pacientes sépticos: estudo observacional. Revista Brasileira de Terapia Intensiva, 2016; 28: 315-322.
23. MOREIRA CORGOZINHO, M, et al. Bone marrow transplants in Brazil: the bioethical dimension. Revista Latinoamericana de Bioética, 12(1): 36-45.
24. MONROE K, et al. Quality Initiative to Improve time to Antibiotics for Febrile Pediatric Patients with Potential Neutropenia. Pediatr Qual Saf. 2018; 3(4): 95.
25. OLIVEIRA AL. Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients, 2007; 39: 775–781.
26. OMS. Step-by-step approach for development and implementation of hospital antibiotic policy and standard treatment guidelines. 2011. Disponível em: apps.who.int/iris/bitstream/handle/10665/205912/B4691.pdf. Acessado em: 25 de agosto de 2024.
27. QUADRI F, et al. Antibacterial drug shortages from 2001 to 2013: implications for clinical practice. Clin Infect Dis, 2015; 60: 1737–1742.
28. RAE N, et al. Oral versus intravenous clarithromycin in moderate to severe community-acquired pneumonia: an observational study. Pneumonia. 2017; 9(1): 2.
29. RODRIGUES R, et al. Perfil de utilização de medicamentos anti-infecciosos sistêmicos em um hospital oncológico. Revista espaço para a saúde, 2014; 15: 42-52.
30. ROSA RG, GOLDANI LZ. Cohort study of the impact of time to antibiotic administration on mortality in patients with febrile neutropenia. Antimicrob Agents Chemother, 2014; 58(7): 3799-803.
31. SBTMO. Sociedade Brasileira de Transplante de Medula Óssea. Diretrizes da Sociedade Brasileira de Transplante de Medula Óssea. 2012. Disponível em: https://sbtmo.org.br/wp-content/uploads/2021/07/Diretrizes_da_Sociedade_Brasileira_de_Transplante_de_Medula_Ossea_2012_ISBN_978-85-88902-17-6.pdf. Acessado em: 25 de Agosto de 2024.
32. SNYDER M, et al. Early antimicrobial de-escalation and stewardship in adult hematopoietic stem cell transplantation recipients: retrospective review. Open Forum Infectious Diseases, 2017; 4: 226.
33. SÖZEN H, et al. Application of ATC/DDD methodology to eveluate of antibiotic use in a general hospital in Turkey. Annals of clinical microbiology and antimicrobials, 2013; 12: 1-6.
34. SPADÃO F, et al. Incidence of diarrhea by Clostridium difficile in hematologic patients and hematopoietic stem cell transplantation patients: risk factors for severe forms and death. Rev. Inst. Med. Trop. Sao Paulo, 2014; 56(4): 325-31.
35. VENTOLA CL. The antibiotic resistance crisis: part 1: causes and threats. Pharmacy and Therapeutics, 2015; 40: 277-83.
36. VINCENTE JL. Nosocomial infections in adult intensive-care units. The Lancet, 2003; 361: 2068-2077.
37. WINGARD JR, et al. Hematopoietic stem cell transplantation: an overview of infection risks and epidemiology. Infectious Disease Clinics, 2010; 24: 257-272.
38. ZHANG H, et al. Allogeneic peripheral blood stem cell and bone marrow transplantation for hematologic malignancies: Meta-analysis of randomized controlled trials. Leukemia Res, 2012; 36: 431-437.