Retrospektivna analiza vzorcev predpisovanja protimikrobnih zdravil na Kliniki Golnik po epidemiji koronavirusne bolezni 19

Voljkar, Špela (author), Kerec Kos, Mojca (mentor), Morgan, Tina (comentor)

Protimikrobna zdravila, predvsem protibakterijska, so pogosto predpisana skupina zdravil. Neustrezno predpisovanje in uporaba lahko vodita v daljše hospitalizacije, večje stroške zdravljenja in večjo odpornost mikroorganizmov, zaradi česar se skozi leta učinkovitost protimikrobnih zdravil pomembno zmanjšuje. Z retrospektivno raziskavo smo želeli pridobiti vpogled v vzorce predpisovanja protimikrobnih zdravil na Kliniki Golnik. Vključili smo 297 bolnikov, ki so bili odpuščeni med 1. 1. in 31. 3. 2022, z najmanj eno od naslednjih odpustnih diagnoz: pljučnica (n = 145), akutno poslabšanje kronične obstruktivne pljučne bolezni (n = 89), bronhitis (n = 22) ali okužba sečil (n = 41). Večina bolnikov je bila starejših, z mediano starosti 72 let, in s pridruženimi obolenji. Najpogostejša povzročitelja okužb dihal sta bila Streptococcus pneumoniae in Haemophilus influenzae, pri okužbah sečil pa Escherichia coli. V vseh skupinah je bil kot začetna protimikrobna terapija najpogosteje predpisan amoksicilin s klavulansko kislino (med 55,9 in 62,1 %), ki se kot zdravilo prve izbire priporoča le pri akutnem poslabšanju kronične obstruktivne pljučne bolezni in težjih oblikah pljučnice. Ozkospektralni penicilini so bili kot začetna terapija uporabljeni le pri enem bolniku in kot nadaljevalna terapija pri treh bolnikih. Protimikrobna terapija je bila ustrezno spremenjena pri 43/95 (45,3 %) bolnikov, pri katerih je bil na voljo antibiogram. Pri 33/95 (34,7 %) bolnikov protimikrobna terapija po prejemu antibiograma ni bila spremenjena oziroma je bila neustrezno spremenjena. S tem so bili bolniki skupno kar 197 dni zdravljeni z neustreznim oziroma neoptimalnim protimikrobnim zdravilom. Pri ostalih bolnikih 19/95 (20,0 %) terapije ni bilo mogoče pravočasno spremeniti zaradi poznega prejema antibiograma ali smrti bolnika pred prejemom antibiograma. Mediana prehoda z intravenske na peroralno terapijo je bila pri bolnikih z akutnim poslabšanjem kronične obstruktivne pljučne bolezni 3,5. dan, pri pljučnici in bronhitisu 5. dan, pri okužbah sečil 5,5. dan. Mediana dolžine zdravljenja z vsaj enim protimikrobnim zdravilom je bila 9 dni pri pljučnici in okužbah sečil, 8 dni pri bronhitisu in 7 dni pri akutnem poslabšanju kronične obstruktivne pljučne bolezni. V primerjavi z obdobjem pred epidemijo koronavirusne bolezni se je trajanje protimikrobne terapije podaljšalo.

• Language: Slovenian
• Keywords: protimikrobno zdravilo, odpornost, mikrobiološka diagnostika, začetna izbira protimikrobne terapije, dolžina zdravljenja.
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2023
• PID: 20.500.12556/RUL-147509
• Publication date in RUL: 07.07.2023

Secondary language

• Language: English
• Title: Retrospective analysis of antimicrobial use patterns at the Universitiy Clinic Golnik in the post-covid-19 epidemic period

Abstract

Antimicrobial drugs, especially antibacterial drugs, are a frequently prescribed group of drugs. Inadequate prescribing and use can lead to longer hospitalizations, higher treatment costs, and greater resistance to microorganisms. As a result, the effectiveness of antimicrobial drugs has significantly decreased over the years. The aim of a retrospective analysis was to gain insight into the patterns of prescribing antimicrobial drugs at the Golnik Clinic. We included 297 patients who got discharged between 1.1. and 31.3. 2022, and received at least one of the following discharge diagnoses: pneumonia (n = 145), acute exacerbation of chronic obstructive pulmonary disease (COPD) (n = 89), bronchitis (n = 22), or urinary tract infection (n = 41). The majority of patients were elderly, with a median age of 72 years, and with comorbidities. The most common causes of respiratory infections were Streptococcus pneumoniae and Haemophilus influenzae, and in urinary tract infections, it was Escherichia coli. In all groups, patients most often received initial antimicrobial therapy with amoxicillin and clavulanic acid (between 55.9 and 62.1%), which are recommended as first-line drugs only in acute exacerbations of COPD and more severe forms of pneumonia. Narrow-spectrum penicillins were prescribed as initial antimicrobial therapy in only one patient and as a follow-up therapy in three patients. 43/95 (45.3%) of patients had their antimicrobial therapy changed appropriately, provided that an antibiogram was available. In 33/95 (34.7%) of the patients, the antimicrobial therapy was either left unchanged, or it was changed inappropriately after receiving the antibiogram. As a result, the patients received the treatment with an inadequate or suboptimal antimicrobial drug for a total of 197 days. The remaining 19/95 (20.0%) patients could not have their therapy changed in time because the antibiogram came in too late or the patients died before receiving the antibiogram. The median transition from intravenous to oral therapy in patients with the acute exacerbation of COPD was 3.5 days, for pneumonia and bronchitis 5 days, and for urinary tract infections 5.5 days. The median length of treatment with at least one antimicrobial drug was 9 days for pneumonia and urinary tract infections, 8 days for bronchitis, and 7 days for acute exacerbation of COPD. Compared to the period before the epidemic of the coronavirus disease, the duration of antimicrobial therapy has increased.

• Keywords: antimicrobial drug, resistance, microbiology diagnosis, initial antimicrobial therapy, length of treatment.