Analiza antimikrobne terapije na Klinici Golnik

Prekomjerno i neprikladno propisivanje antimikrobnih lijekova u bolnicama dovodi do pojave nuspojava i antimikrobne rezistencije, što rezultira produljenjem hospitalizacije bolesnika i povećanjem troškova u zdravstvu. Zbog toga je program Nadzora korištenja protumikrobnih lijekova (engl. Antimicrobial stewardship, AMS) implementiran u brojne institucije u cijelom svijetu, s naglaskom na racionalnu upotrebu antimikrobnih lijekova. Kako bi uspostavili ključne aktivnosti AMS programa u Klinici Golnik, potrebno je prikupiti podatke o propisanim antimikrobnim terapijama. Stoga je cilj ovog rada bio identificirati i opisati uzorke propisivanja antimikrobnih lijekova za glavne infektivne dijagnoze na klinici – upalu pluća, akutno pogoršanje KOPB-a, akutni bronhitis i urinarne infekcije. Podaci su prikupljeni i analizirani retrospektivno među 106 pacijenata, pokazujući trend propisivanja antimikrobnih terapija i dajući sljedeće rezultate: nepotpuna dokumentacija kod 25,47% pacijenata je istaknula potrebu za unošenjem detaljnijih podataka u medicinske kartone. 58,49% analiziranih pacijenata je primalo antimikrobnu terapiju iako testiranjem nije potvrđena bakterijska infekcija. Gotovo polovica empirijskih terapija je uključivala amoksicilin s klavulanskom kiselinom. Štoviše, prema gruboj procjeni sakupljenih podataka, skoro polovica terapija nisu bile u skladu sa smjernicama i/ili pacijentovim kliničkim stanjem. Iako je medijan trajanja terapije iznosio 7 dana, 32,08% pacijenata je bilo liječeno duže od 10 dana, što je vjerojatno povezano s niskom stopom sužavanja spektra djelovanja antibiotika (8,49%). Dobra praksa je primjenjena kod zamjene parenteralnog s oralnim putem administracije lijeka, kod 77,55% pacijenta. Vjerujemo da bi detaljniji elektronički medicinski kartoni pacijenata pružili točnije i dostupnije podatke za buduće analize i optimizaciju antibiotske terapije. Excessive and inappropriate prescribing of antimicrobial drugs in hospitals leads to emergence of adverse reactions and antimicrobial resistance, which results in the prolongation of in-patient hospitalizations and increase of healthcare expenses. For that reason, Antimicrobial stewardship (AMS) programme was implemented in numerous institutions worldwide focusing on the rational use of antimicrobials. In order to implement the core elements of AMS programme in the University clinic Golnik, the collection of data on prescribed antimicrobial therapies is needed. Therefore, the aim of this study was to identify and descriptively describe the prescription patterns of antimicrobial prescribing for main infectious diagnoses at the University Clinic Golnik – pneumonia, acute bronchitis, acute exacerbation of chronic obstructive pulmonary disease and urinary tract infections. Data were collected and analyzed retrospectively among 106 patients, showing the trend of prescribed antimicrobials and providing the following results: incomplete data on 25.47% of patients pointed out the necessity for entering more detailed notes in medical records. 58.49% of analyzed patients received antimicrobial therapy even though bacterial infection was not confirmed. Almost half of empiric therapies included amoxicillin-clavulanate. Moreover, rough assessment of collected data shows that almost one half of therapies were not appropriate according to the guidelines and/or patients' medical condition. Even though median length of therapy was 7 days, 32.08% of patients were treated for longer than 10 days, which may be linked with low occurrence of therapy streamline (8.49%). Good practice was shown in switching for intravenous to oral route of drug administration, which occurred in 77.55% of patients. We believe that more detailed electronic medical charts could provide more accurate and easier accessible data for future analyses and optimization of the antibiotic therapy.