Avaliação de terapia antimicrobiana empírica e adaptação a antibiograma numa clínica de terceiro nível de Tunja
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Objetivo: determinar a frequência de tratamento antibiótico empírico adequado e apropriado numa unidade de cuidado intensivo na Colômbia.
Metodologia: estudo observacional analítico. Se recorreu informação dos registros clínicos e microbiológicos da unidade de cuidado intensivo (UCI) da Clínica de Tunja. Se analisaram os regímenes antibióticos empíricos, os antibiogramas e a porcentagem de adaptação aos resultados dos cultivos. Se determinou a porcentagem de terapia empírica apropriada e adequada de acordo com os cultivos e seus antibiogramas
Resultados: se estudaram 198 casos de infecção em UCI entre julho de 2 008 e setembro de 2 011. 75% das infecções se documentou por meios microbiológicos, correspondentes a 148 pacientes com 165 microrganismos. Em 94 dos 148 pacientes com infecção documentada por cultivos, o tratamento empírico foi apropriado (64%). Nos casos de infecção não documentada por cultivos, a terapia empírica foi adequada em 36 dos 50 pacientes (72%). Em 128 (65%) dos casos se cambiou o tratamento empírico. O tratamento empírico foi apropriado em 100% dos casos que recebeu o régime imipenem, piperacilina/tazobactam e amikacina, comparado com 68% quando se utilizou imipenem/ amikacina (p <0.001) e 29% quando se empregou só imipenem (p <0.001).
Conclusões: a porcentagem de terapia empírica adequada e apropriada foi baixa (65.6%) e aumenta com a combinação de três antimicrobianos, em populações com alta probabilidade de infecções por germes multirresistentes.
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Referências
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