Stewardship Brasil : avaliação nacional dos programas de gerenciamento do uso de antimicrobianos em Unidade de Terapia Intensiva pediátrica dos hospitais brasileiros.

Abstract

Introduction: Antimicrobial resistance is a global problem that requires the implementation of Antimicrobial Stewardship Programs (ASPs) to combat it. These programs have shown efficacy in optimizing therapy, reducing toxicity, and improving clinical outcomes. In Latin America and Brazil, where there is a high prevalence of resistant infections, the implementation of ASPs is crucial, especially in Pediatric Intensive Care Units (PED-ICU). Antimicrobial control involves measures to optimize therapy and improve clinical outcomes, making it essential for these programs to be adopted in hospitals to ensure patient safety and therapeutic efficacy. The objective is to assess the implementation of ASPs in Brazilian hospitals with PED-ICU. Article 1: Factors influencing the implementation of antimicrobial stewardship programs in pediatric intensive care units in Brazil. Objective: To assess the implementation of antimicrobial stewardship programs (ASP) in pediatric intensive care units (PED-ICU) in Brazil. Design: Prospective cross-sectional. Setting: The study included 29 PED-ICU from Brazil. Methods: This multicenter study was conducted over 2 months Jul-Aug 2019. To evaluate the ASPs, an institutional survey of the facilitating factors that guided the implementation of the ASP was requested. Results: Out of the 29 PED-ICU in Brazil that completed the study, 20 (69%) had an ASP implemented. The most frequent factors favouring the ASP were the existence of clinical protocols for the most frequent infections according to the healthcare setting profile in 15 (75%) hospitals, and support and adherence by the prescribers of the hospital 13 (65%). Among the reasons that hindered the implementation of the ASP, the lack of information technology support stood out 8 (40%), the lack of engagement of the hospital teams in the execution of program actions 7 (35%) as well as little support from the top management of the hospital 7 (35%). The availability of diagnostic tools were highlighted as facilitators for the Program. Conclusion: The implementation of the ASP in PED-ICUs requires strong support from the hospital's senior management. This includes forming a specialized team and allocating the necessary resources to ensure the program's effectiveness. Such an initiative is crucial for improving clinical outcomes and combating AMR, highlighting the importance of ASP for more responsible use of antimicrobials.