Stewardship Brasil : avaliação nacional dos programas de gerenciamento do uso de antimicrobianos em unidade de terapia intensiva adulto dos hospitais brasileiros.

Abstract

Introduction: Antimicrobial management programs are used as a way to guide the appropriate use of these drugs, with the aim of improving the clinical results of infectious diseases, reducing the appearance of antimicrobial resistance, and reducing the risks of adverse reactions. Objective: To evaluate the national panorama of antimicrobial management programs in Brazilian hospitals with adult ICUs. Article 1: Development and validation of an information collection instrument for a multicenter study with an approach on the Antimicrobial Stewardship Program. Introduction: so that a questionnaire can be used on a large scale and has an acceptable level of reliability and it is necessary to carry out the validation process. The internal consistency of the instrument's items quantifies how similarly and interrelated the items represent a result construct that the instrument intends to measure, while reliability is defined as the square correlation between the true score and the observed score. Objective: to develop and validate an instrument designed to evaluate the implementation of antimicrobial use management programs in an adult intensive care unit in Brazilian hospitals. Method: the questionnaire development and validation process comprised two distinct stages, the first stage being carried out with a team of specialists in the field, in which they were invited to evaluate the content for relevance, adequacy and clarity. The second stage comprised a pilot validation, carried out by twelve Brazilian hospitals with various levels of implementation of the management of antimicrobials, which evaluated adequacy and clarity. The questionnaire was divided between the hospitals that had and the hospitals that did not have the antimicrobial management implemented, those that had 50% or more of the actions developed were considered as implemented. The answers were organized in an ordinal way, using the Likert scale of 5 points, being used to obtain the agreement of the respondents. Results: The interpretation of Cronbach's alpha coefficient is apparently intuitive because, in most cases, the values vary between zero and 1. It is understood, then, that the internal consistency of a questionnaire is all the greater the closer to 1 the value is. of the statistics, in this way the questionnaire has satisfactory internal consistency, since of the six components analyzed, four were considered good with α> 0.8 and one component was considered excellent α> 0.9. Conclusion: The validation presented in this work showed that the developed questionnaires can be used as accurate and reliable tools to measure the implementation of national antimicrobial management programs, and can be replicated in a safe and reliable way. Article 2: Antimicrobial Stewardship Programs in Brazil: preliminary results. Introduction: The worldwide trend of clinical management of the use of antimicrobials through the Antimicrobial Stewardship Program (ASP) aims to rationalize therapy. The need to diagnose the Brazilian national panorama is essential to outline strategies due to regional differences and to standardize government regulations. Objective: In this context, the study aimed to verify the implementation of the Antimicrobial Stewardship Program (ASP) in an adult ICU in Brazil. Method: This is a prospective cross-sectional study nationwide, containing preliminary data from 954 (56.0%) hospitals with an Adult Intensive Care Unit (ICU), corresponding to 25,565 beds, from all 27 Brazilian states, containing the variables that contributed to and favored the implementation of ASP. Data collection was carried out in July and August 2019. Results: Of the 954 hospitals, 453 (47.5%) stated that they had ASP implemented and among the most frequent factors that favored the program were: 369 (81.5%) with support from the hospital's top management; 343 (75.7%) with availability of clinical protocols based on the institutional profile; 276 (60.9%) with support and adherence from prescribing physicians and 259 (57.2%) with official definition of a multiprofessional group (management team) responsible for the preparation of ASP. Among the main reasons that hindered the implementation were: 202 (44.6%) components of the operational team with no defined or sufficient time to perform ASP activities; 134 (29.6%) with no information technology support; 173 (38.2%) with resistance or opposition from the hospital's prescribing doctors and 116 (25.6%) with lack of commitment from hospital teams to implement the ASP rules. Conclusion: ASP is a viable strategy for the optimization and rational use of antimicrobials in developing countries. In Brazil, this plan is still under development, but it will collaborate for objective actions in the ICUs, directed by the government, with an important impact for the sustainability of the control of the spread of antimicrobial resistance in the country.