Uso de antimicrobianos e ocorrência de lesão renal aguda em pacientes internados em um hospital do Oeste do Pará.

Abstract

Pharmacovigilance is increasingly used by the pharmaceutical professional to improve the care he provides in the hospital environment. In studies on adverse drug reactions, among the classes most likely to promote organ damage are antimicrobials. This class of drugs can induce nephrotoxicity and cause complications in the treatment of patients. One of the most common problems with high incidence rates in the hospital setting is the occurrence of acute kidney injury (AKI), a complication that affects most patients and can lead to kidney failure or even death. The purpose of this study was to evaluate the incidence of acute renal damage in patients hospitalized under nephrotoxic antimicrobial exposure at the Baixo Amazonas Regional Hospital, as well as to describe the demographic and clinical profile of the patients, to verify serum creatinine variation durang the use of antimicrobial with potential to promote nephrotoxicity and to determine concentrations of vancomycin. The study was a prospective and observational cohort study in hospitalized patients from October 2018 to January 2019. Patients were assessed for inclusion criteria and exclusion from the study on the fifth day of hospitalization. The medical records, prescriptions and results of laboratory tests available in the patients' records were used as data collection sources. The included participants were interviewed and monitored for the identification of the development of AKI according to KDIGO guidelines and also the plasma quantification of vancomycin concentrations in the patients who used this antibiotic. A total of 70 patients, with a mean age of 52,49  20,31 years, were the most male (64,29%, n = 45) and from the oncology clinic (34,29%; n = 24). Of the patients followed up, 48,57% (n = 34) developed AKI, 20,59% (n = 7) reached stage 3 of AKI. 20,00% (n = 14) of the patients died, of which seven had developed AKI. A mean of 10,26  2,9 medications prescribed per patient was identified. The most commonly prescribed antimicrobials were ceftriaxone, cefepime and piperacillin / tazobactam. Of the patients who used amphotericin B in the infectious treatments, 100% (n = 2) presented AKI and 60% (n = 6) of the patients who received the antibiotic vancomycin were diagnosed with AKI. The results of vancomycin plasma concentrations showed that patients who developed AKI during the use of vancomycin presented concentrations ranging from 3 μg/mL to 15,9 μg/mL, the majority of which were below the recommended minimum concentration (10 - 20 μg/ml). Even with low plasma concentrations of vancomycin, the use of this antibiotic with other nephrotoxic drugs may have contributed significantly to the development of AKI. The understanding of the factors associated with the occurrence of AKI in patients admitted to the hospital under nephrotoxic antimicrobial exposure is of great relevance, since it serves as a subsidy for the early identification of drug-induced renal dysfunction, favoring the prevention and proper management of these patients, it also reinforces the importance of the pharmacist's role in the care of critical patients.