O impacto do perfil de resistência antimicrobiana ao uso de antibióticos em UTI pós pandemia covid-19

Abstract

Introduction: Antimicrobial resistance is a growing public health problem, exacerbated by the inappropriate use of antibiotics, especially during the Covid-19 pandemic. The World Health Organization predicts that, by 2050, more than 10 million people could die annually due to superbugs. Among the main pathogens are Enterobacteriaceae and Pseudomonas aeruginosa. Control of healthcare-associated infections (HAIs) requires effective prevention measures, such as hand hygiene and correct use of PPE. Objective: To evaluate the impact of the antimicrobial resistance profile on the use of antibiotics in Intensive Care Units (ICU) after the Covid-19 pandemic. Methodology: Cross-sectional, analytical and retrospective study of medical records of patients admitted to the adult ICU between 2019 and 2021 in a reference hospital for infectious diseases in the state of Piauí. Two data collection forms were used: one with data related to the sociodemographic and clinical profile of patients diagnosed with HAIs and another with data on the bacterial profile, samples with positive results and antimicrobial resistance in the pre- and post-Covid-19 period. The Statistical Package for the Social Sciences was used for data analysis, with descriptive statistics being performed, and the Chi-Square Test and Fisher's Exact Test were performed for inferential analysis. The research was approved under number 6,740,157. Results: Antimicrobial resistance to the use of antibiotics in ICUs increased during and after the Covid-19 pandemic. The microorganisms with the greatest resistance were Pseudomonas aeruginosa, Klebsiella pneumoniae carbapenemase, Acinetobacter baumannii and E. coli, with emphasis on Gram negative ones. Ceftriaxone was the most widely used antibiotic. Multidrug resistance was significantly associated with Pseudomonas aeruginosa, Staphylococcus haemolyticus, and Enterococcus faecalis in 2019, and with Klebsiella pneumoniae carbapenemase and E. coli in the post-pandemic period, with COVID-19 co-infection standing out with Pseudomonas aeruginosa. Conclusion: An increase in the prevalence of HAIs in ICU patients was observed, as well as an increase in the use of antimicrobials and antimicrobial resistance. Information on the prevalence of infections and antimicrobial resistance is essential to update institutional protocols and clinical practices. They help to formulate response strategies, influence public policies, and enrich the scientific literature. Continuous surveillance and studies on new diseases are crucial for the control of HAIs.