Socioeconomic Determinants of Antibiotic Consumption in the State of São Paulo, Brazil: The Effect of Restricting Over-The-Counter Sales.

BACKGROUND: Improper antibiotic use is one of the main drivers of bacterial resistance to antibiotics, increasing infectious diseases morbidity and mortality and raising costs of healthcare. The level of antibiotic consumption has been shown to vary according to socioeconomic determinants (SED) such as income and access to education. In many Latin American countries, antibiotics could be easily purchased without a medical prescription in private pharmacies before enforcement of restrictions on over-the-counter (OTC) sales in recent years. Brazil issued a law abolishing OTC sales in October 2010. This study seeks to find SED of antibiotic consumption in the Brazilian state of São Paulo (SSP) and to estimate the impact of the 2010 law. METHODS: Data on all oral antibiotic sales having occurred in the private sector in SSP from 2008 to 2012 were pooled into the 645 municipalities of SSP. Linear regression was performed to estimate consumption levels that would have occurred in 2011 and 2012 if no law regulating OTC sales had been issued in 2010. These values were compared to actual observed levels, estimating the effect of this law. Linear regression was performed to find association of antibiotic consumption levels and of a greater effect of the law with municipality level data on SED obtained from a nationwide census. RESULTS: Oral antibiotic consumption in SSP rose from 8.44 defined daily doses per 1,000 inhabitants per day (DID) in 2008 to 9.95 in 2010, and fell to 8.06 DID in 2012. Determinants of a higher consumption were higher human development index, percentage of urban population, density of private health establishments, life expectancy and percentage of females; lower illiteracy levels and lower percentage of population between 5 and 15 years old. A higher percentage of females was associated with a stronger effect of the law. CONCLUSIONS: SSP had similar antibiotic consumption levels as the whole country of Brazil, and they were effectively reduced by the policy

Surto policlonal de infecção de corrente sanguínea causada pelo complexo Burkholderia cepacia em unidades de hospital-dia de hematologia e transplante de medula óssea

Aim: The objective was to describe an outbreak of bloodstream infections by Burkholderia cepacia complex (Bcc) in bone marrow transplant and hematology outpatients. Methods: On February 15, 2008 a Bcc outbreak was suspected. 24 cases were identified. Demographic and clinical data were evaluated. Environment and healthcare workers' (HCW) hands were cultured. Species were determined and typed. Reinforcement of hand hygiene, central venous catheter (CVC) care, infusion therapy, and maintenance of laminar flow cabinet were undertaken. 16 different HCWs had cared for the CVCs. Multi-dose heparin and saline were prepared on counter common to both units. Findings: 14 patients had B. multivorans (one patient had also B. cenopacia), six non-multivorans Bcc and one did not belong to Bcc. Clone A B. multivorans occurred in 12 patients (from Hematology); in 10 their CVC had been used on February 11/12. Environmental and HCW cultures were negative. All patients were treated with meropenem, and ceftazidime lock-therapy. Eight patients (30%) were hospitalized. No deaths occurred. After control measures (multidose vial for single patient; CVC lock with ceftazidime; cleaning of laminar flow cabinet; hand hygiene improvement; use of cabinet to store prepared medication), no new cases occurred. Conclusions: This polyclonal outbreak may be explained by a common source containing multiple species of Bcc, maybe the laminar flow cabinet common to both units. There may have been contamination by B. multivorans (clone A) of multi-dose vials.O objetivo foi descrever um surto de infecções da corrente sanguínea por complexo B. cepacia (Bcc) nos ambulatórios de hematologia e transplante de medula óssea. Métodos: Em 15/02/2008, um surto de Bcc foi suspeitado. 24 casos foram identificados. Os dados demográficos e clínicos foram avaliados. Mãos de profissionais da saúde e ambiente foram cultivadas. Espécies foram determinadas e tipadas. Reforço da higiene das mãos, cuidados com cateteres, terapia de infusão e manutenção da câmara de fluxo laminar foram realizadas. 16 profissionais de saúde (PS) diferentes manipularam os cateteres. Heparina multidoses e soro eram preparadas em um balcão comum a ambas as unidades. Resultados: 14 pacientes tiveram B. multivorans (um paciente teve também B. cenopacia), 6 Bcc não-multivorans e um teve um agente não pertencente a Bcc. Clone A de B. multivorans ocorreu em 12 pacientes (da Hematologia), em 10 o cateter havia sido utilizado nos dias 11 ou 12 de fevereiro. Culturas ambientais e de PS foram negativos. Todos os pacientes foram tratados com meropenem e selo de ceftazidima. Oito pacientes (30%) foram hospitalizados. Não ocorreram mortes. Após as medidas de controle, nenhum novo caso ocorreu. Conclusões: Este surto policlonal pode ser explicado por uma fonte comum contendo várias espécies de Bcc, talvez a câmara de fluxo laminar comum a ambas as unidades. Pode ter havido contaminação por B. multivorans (clone A) de frascos multi-dose

Characterization of epidemiological surveillance systems for healthcare-associated infections (HAI) in the world and challenges for Brazil

Surveillance systems for healthcare-associated infections (HAI) are essential for planning actions in prevention and control. Important models have been deployed in recent decades in different countries. This study aims to present the historical and operational characteristics of these systems and discuss the challenges for Brazil. Various models around the world have drawn on the experience of the United States, which pioneered this process. In Brazil, several initiatives have been launched, but the country still lacks a full national information system on HAI, thus indicating the need to promote action strategies, strengthen the role of States in communication between the Federal and local levels, pursue a national plan to organize surveillance teams with the necessary technological infrastructure, besides updating the relevant legislation for dealing with these challenges. Such measures are essential in the Brazilian context for the unified surveillance of HAI, aimed at healthcare safety and quality

O IMPACTO DO FARMACÊUTICO CLÍNICO COM DEDICAÇÃO EXCLUSIVA NO PROGRAMA DE GERENCIAMENTO DE ANTIMICROBIANOS EM HOSPITAL PRIVADO DE SÃO PAULO

Introdução/Objetivo: O Programa de Gerenciamento de Antimicrobianos (PGA) tem papel essencial na otimização do uso dessas drogas, aumento da segurança em seu uso e redução na resistência microbiana, com benefício potencial também na redução de custos hospitalares. O farmacêutico clínico tem papel-chave para um programa eficaz, porém, barreiras orçamentárias, falta de farmacêuticos treinados em doenças infecciosas e restrições de quadro de colaboradores costumam impedir a implantação de programas robustos. O objetivo deste trabalho é avaliar o impacto da dedicação exclusiva de um farmacêutico clínico no PGA. Métodos: Trata-se de estudo tipo antes e depois realizado em hospital terciário privado na cidade de São Paulo com 350 leitos. Foram mensurados o número, tipo e adesão às intervenções farmacêuticas relacionadas a antimicrobianos (IF) durante 3 meses anteriores à dedicação exclusiva do farmacêutico ao PGA (novembro 2022 a janeiro 2023) e comparados aos 3 meses após (março a maio 2023). Não houve mudança no número total de farmacêuticos. Foram mensurados também o uso de antimicrobianos em dose diária definida por 1000 pacientes-dia e o impacto financeiro das IF em custo direto com antimicrobianos. Resultados: Na comparação entre o período antes e depois da dedicação exclusiva de um farmacêutico ao PGA, o total de IF passou de 743, com adesão de 85%, para 1010, com adesão de 77%. Esse resultado representa aumento de 35% nas IF. Os tipos de intervenção que sofreram maior impacto foram descalonamento, indo de 11 para 67, acréscimo de 509%, e suspensão de antimicrobiano terapêutico, indo de 42 para 86, acréscimo de 104%. Tais resultados tiveram contribuição em redução no consumo de Meropenem (13%) e de Piperacilina-tazobactam (8%) e aumento no consumo de Ceftazidima (60%) na UTI, o que pode representar descalonamento das drogas anteriores baseado em perfil microbiológico local. Em relação ao impacto financeiro das IF do farmacêutico do PGA, as intervenções de descalonamento economizaram R$13.877, as suspensões de antibiótico terapêutico oportunizaram redução de custo de R$ 7.048 e as intervenções de ajuste terapêutico resultaram em decréscimo de R$ 14.783. Conclusão: Apesar de o recorte de tempo de 3 meses ser pequeno, nosso trabalho mostrou que a introdução de profissional dedicado tem potencial para melhoria da qualidade das intervenções e com resultado rápido

Multivariable regression models.

<p>Multivariable regression models.</p

Oral antibiotic consumption by meso-region in 2008, 2010 and 2012.

<p>*DID: defined daily doses per 1,000 inhabitants per day.</p

Linear regression results for univariate analysis.

<p>Linear regression results for univariate analysis.</p

How new molecular tools can help bugbusters: a Burkholderia cepacia complex outbreak investigation

An outbreak of bloodstream infection (BSI) caused by members of the Burkholderia cepacia complex (Bcc) took place from March 2012 until April 2014 involving thirteen patients. Aim. To describe an outbreak investigation of BSI Bcc and showing how genetic sequencing tools contributed to confirm the hypothesis of extrinsic contamination proposed by an observational study. Methods. The Infection Control Department revised and reinforced good practices of infusion therapy and catheter care, visits to affected wards, a case control study, and environmental screening based on the case-control findings. Results. Data from the case-control study found an association of cases with central venous catheter (OR 1.36; CI 1.15-1.67) and intravenous cisatracurium use (OR 10.75; CI 1.67-68.89). Visits to the operatory block revealed problems related to the cold chain used for the preservation of thermolabile cisatracurium. We could not retrieve Bcc from environmental samples using classic microbiology. New samples from the same surfaces were obtained for genetic sequencing. Bcc was identified in the cooler box, refrigerator and reusable ice packages. Conclusion. Environmental screening using genetic sequencing proved to be a useful tool for confirming our hypothesis of extrinsic contamination raised by the case-control study