Análise da antibioticoprofilaxia em um hospital de alta complexidade do Oeste do Pará

Abstract

The objective of this study was to evaluate the use of antimicrobials for prophylactic purposes in patients in the pre, intra and postoperative periods. The study refers to a quantitative, descriptive, exploratory, documentary and cross-sectional investigation conducted in a public hospital of medium and high complexity in the city of Santarém/PA, using the promptuaries of surgical patients as a source of data from the year 2020. The data obtained were analyzed using descriptive statistics. The variables of interest were: gender, age, length of stay, type of surgery, use of prophylactic antimicrobials in the pre, intra, and postoperative periods, dose repetition, time of administration, recommendation of the Commission for Hospital Infection Control (CCIH), appropriate use, and occurrence of infection during hospitalization. A total of 101 surgical patient records were analyzed, with (52.5%) being women and the most prevalent ages ranging from 30 to 44 years (33.7%). Surgeries were predominantly elective (99.0%), distributed among 10 surgical specialties, with the highest frequency of orthopedic surgery (39; 38.6%) and general surgery (26; 25.7%), oncology and urology specialties with 8 procedures each (16; 17.2%), buccomaxillofacial specialties, gynecology, neurology, gastroenterology, otolaryngology, and vascular surgery were less frequent. The drug Cefazolin was the most prescribed for antibiotic prophylaxis (93.5%). Administration of antimicrobial prophylaxis at the time of induction of anesthesia occurred for (92; 91.1%) patients, with no record of administration of a supplemental dose during surgical procedures. Using the data reported in the promptuaries, it was not possible to show the exact time of discontinuation of these medications. The surgical procedures performed in gynecology, urology, neurology, orthopedics, and otolaryngology followed the recommendations of the institutional protocol regarding the correct choice of drug in relation to the type of surgery, dose, and route of administration in antibiotic prophylaxis. In vascular surgery, it complied with the recommendations, since there is no indication for prophylactic antimicrobial for the surgical procedure performed. Non-compliance occurred in some surgical procedures in oncology, while in buccomaxillofacial surgery, general surgery, and gastroenterology it was not possible to analyze whether or not it was in compliance due to data not collected in most medical records regarding this variable. As for the postoperative period at hospital discharge, it was found that the vascular surgery and gastroenterology specialties complied with the recommendations of the institutional protocol, not prescribing antimicrobials. In all other specialties, patients left the hospital with a prescription for antimicrobials. It is concluded that the studied institution has well structured principles of recommendations on the control of prevention of hospital infection in surgical patients and the practice of antibiotic prophylaxis meets the recommendations of the institutional protocol regarding the correct choice of the drug on the type of surgery, dose, time of onset, and route of administration, for most surgical specialties studied, but with evidence of prolonged use of antimicrobials at hospital discharge, suggesting a possible failure to comply with the safe surgery protocol. Awareness campaigns of the medical team for prescribing antimicrobials at hospital discharge are suggested in order to prevail the rational use of antimicrobials avoiding indiscriminate or abusive use, considered as the main causes of antimicrobial resistance.