Evaluación de terapia antimicrobiana empírica y adaptación a antibiograma en una clínica de tercer nivel de Tunja
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Objetivo: determinar la frecuencia de tratamiento antibiótico empírico adecuado y apropiado en una unidad de cuidado intensivo en Colombia.
Metodología: estudio observacional analítico. Se recogió información de los registros clínicos y microbiológicos de la unidad de cuidado intensivo (UCI) de la Clínica de Tunja. Se analizaron los regímenes antibióticos empíricos, los antibiogramas y el porcentaje de adaptación a los resultados de los cultivos. Se determinó el porcentaje de terapia empírica apropiada y adecuada de acuerdo con los cultivos y sus antibiogramas.
Resultados: se estudiaron 198 casos de infección en UCI entre julio de 2008 y septiembre de 2011. El 75% de las infecciones se documentó por medios microbiológicos, correspondientes a 148 pacientes con 165 microorganismos. En 94 de los 148 pacientes con infección documentada por cultivos, el tratamiento empírico fue apropiado (64%). En los casos de infección no documentada por cultivos, la terapia empírica fue adecuada en 36 de los 50 pacientes (72%). En 128 (65%) de los casos se cambió el tratamiento empírico. El tratamiento empírico fue apropiado en 100% de los casos que recibió el régimen imipenem, piperacilina/tazobactam y amikacina, comparado con el 68% cuando se utilizó imipenem/amikacina. (p <0.001) y 29% cuando se empleó sólo imipenem (p <0.001).
Conclusiones: el porcentaje de terapia empírica adecuada y apropiada fue baja (65.6%) y aumenta con la combinación de tres antimicrobianos, en poblaciones con alta probabilidad de infecciones por gérmenes multirresistentes.
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