{"id":116583,"date":"2014-04-11T00:00:00","date_gmt":"2014-04-11T00:00:00","guid":{"rendered":""},"modified":"2014-04-11T00:00:00","modified_gmt":"2014-04-11T00:00:00","slug":"uso-de-antibioticos-en-el-hospital-clinico-universitario-virgen-de-la-arrixaca-2012-estudio-descriptivo-patrones-de-cambio-1978-1982-2012-e-influencia-del-tratamiento-antibiotico-protocolizado-en","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/enfermedades-infecciosas\/uso-de-antibioticos-en-el-hospital-clinico-universitario-virgen-de-la-arrixaca-2012-estudio-descriptivo-patrones-de-cambio-1978-1982-2012-e-influencia-del-tratamiento-antibiotico-protocolizado-en\/","title":{"rendered":"Uso de antibioticos en el hospital clinico universitario virgen de la arrixaca 2012: estudio descriptivo, patrones de cambio (1978-1982-2012) e influencia del tratamiento antibiotico protocolizado en la evolucion de los pacientes con infecciones"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Cristina Bonillo Garcia <\/strong><\/h2>\n<p>Objetivos:  1. Describir el uso de antibi\u00f3ticos en el hospital cl\u00ednico universitario virgen de la arrixaca (hcuva) 2012. 2. Valorar la influencia de la protocolizaci\u00f3n del tratamiento antibi\u00f3tico en la evoluci\u00f3n del paciente con proceso infeccioso 3.  Analizar los patrones de cambio en el uso de antibi\u00f3ticos (1978-1982-2012) 4. Evaluar los conocimientos, actitudes y las pr\u00e1cticas de prescripci\u00f3n de antibi\u00f3ticos entre los m\u00e9dicos del hcva  pacientes y m\u00e9todos:  1. Estudio  prospectivo de todos los pacientes que recibieron tratamiento antibi\u00f3tico a lo largo del mes de abril de 2012.  2. Se analizaron los factores asociados a mortalidad y fallo terap\u00e9utico, definido como, persistencia microbiol\u00f3gica, recidiva o muerte. La significaci\u00f3n estad\u00edstica p &lt;0,05  3. Las prescripciones de antibi\u00f3ticos fueron analizadas y comparados con las del mes de abril de 1978 (sin protocolo), 1982 (creaci\u00f3n de comisi\u00f3n de enfermedades infecciosas y establecimiento de las l\u00edneas generales del control de antibi\u00f3ticos) y 2012 (protocolos  bien establecidos y definidos incluyendo directrices para el tipo de infecci\u00f3n y  gravedad). Significaci\u00f3n estad\u00edstica p &lt;0,05 4. Cuestionarios autoadministrados.  resultados:  1. 602 pacientes de 1265 pacientes ingresados durante el mes de estudio recibieron tratamiento antibi\u00f3tico, siendo 178 considerado como prescripciones profil\u00e1cticas  y 342 tratamientos como emp\u00edricos. Ceftriaxona y levofloxacino fueron los antibi\u00f3ticos administrados con mayor frecuencia; 69% de los 424 tratamientos (no profil\u00e1cticos) fueron considerados como adecuados. Hubo fracaso cl\u00ednico en 110 casos (27%), fracaso microbiol\u00f3gico en 49 (13%), reca\u00edda en 31 (8%) y muerte en 30 (7,5%). 2. Los factores asociados al fallo cl\u00ednico fueron, tratamiento inadecuado (or 5.68, ic 95%: 2,898 a 11,217) y aislamiento de e. Coli con producci\u00f3n de blee (or 4,43 (ic del 95%: 1,492 a 13,184).  3. En el a\u00f1o 1978, el 46% de los pacientes ingresados recibieron tratamiento antibi\u00f3tico, el 33% en 1982 y 49% en 2012 (p &lt;0,05). En cuanto a los servicios m\u00e9dicos, la prescripci\u00f3n de antibi\u00f3ticos afectaba al 37%, 47% y 59% de los pacientes, en 1978, 1982 y 2012, respectivamente (p &lt;0,05). La tasa de adecuaci\u00f3n fue de 49%, 53% y 69% en los 3 periodos diferentes (p &lt;0,05 para el a\u00f1o 2012 en comparaci\u00f3n con 1978 o 1982); 35%, 32% y 21% de los pacientes recibieron m\u00e1s de  2 antibi\u00f3ticos en 1978, 1982 y 2012, respectivamente (p &lt;0,05 para el a\u00f1o 2012 en comparaci\u00f3n con 1978 o 1982).  4. Se completaron un total de 316 cuestionarios; dosis de antibi\u00f3tico, v\u00eda de administraci\u00f3n y duraci\u00f3n del tratamiento se ajustaron siempre seg\u00fan la localizaci\u00f3n de la infecci\u00f3n y las condiciones subyacentes en un 65%, 68% y 45%, respectivamente. La desescalada antibi\u00f3tica fue reconocida como pr\u00e1ctica habitual en el 20%; las posibles resistencias microbiol\u00f3gicas y el coste econ\u00f3mico fueron considerados en un 31% y el 10%  respectivamente;  el 69% admite la administraci\u00f3n de ab con, probablemente, ninguna indicaci\u00f3n cl\u00ednica.    conclusiones:  1. De 1265 pacientes ingresados en el hcuva, 602 (49%) recibieron tratamiento antibi\u00f3tico. Los antibi\u00f3ticos m\u00e1s usados fueron ceftriaxona y levofloxacino en los tratamientos terap\u00e9uticos y amoxicilina\/ clavul\u00e1nico en los profil\u00e1cticos. La elecci\u00f3n del antibi\u00f3tico seg\u00fan protocolo fue adecuada en un 68,9% con una curaci\u00f3n del 72,13%. 2. Como factores independientes asociados a peor evoluci\u00f3n en el an\u00e1lisis multivariante encontramos, el  tratamiento emp\u00edrico y dirigido no adecuado  a protocolo ; infecci\u00f3n por e.Coli multiresistente con blee y\/o  r a ciprofloxacino ; duraci\u00f3n no adecuada del tratamiento antibi\u00f3tico y la gravedad cl\u00ednica inicial cr\u00edtica 3. Como patrones de cambio en 2012 encontramos que el uso de antibi\u00f3ticos se asoci\u00f3 de forma significativa, con mayor adecuaci\u00f3n, incremento de las prescripciones en los servicios m\u00e9dicos y aumento de la monoterapia como principal r\u00e9gimen terap\u00e9utico en comparaci\u00f3n a los estudios de 1978 y 1982. No encontramos diferencias de su consumo entre 1978 y 2012. 4 .Las respuestas obtenidas en esta encuesta ponen de manifiesto el aparentemente limitado conocimiento de los m\u00e9dicos hospitalarios   objetives: 1. To descriptive the use of antibiotics in the clinical univertitary hospital virgen de la arrixaca (hcuva).  2. To analyze factors associated to &quot;failure&quot; in patients under antibiotic treatment with infectious process 3. To analyze antibiotic prescription (abp) at our hospital comparing 3 different periods of time with different abp policies (abpp). 4. To evaluate knowledges attitudes and practices of antibiotic prescribing among doctors at a university hospital. patients and methods: 1. All patients receiving an antibiotic treatment along april 2012 were prospectively observed. 2. Factors associated to mortality and clinical failure were analyzed. Failure was defined as microbiological failure, relapse or death. Statistically significance was established as p&lt;0.05 3. All abp per in-patients along april were analyzed and compared in 1978 (no special abpp), 1982 (an infectious diseases comity was created and general lines of abpp were established) and 2012 (abpp were well established and defined including guidelines by infection and severity). Statistically significance was established as p&lt;0.05 4. Self-administered questionnaires. results:  1. 602 of 1265 admitted patients during the study month included an ab in their medical prescriptions, being 178 considered as prophylactic ab prescriptions and 342 as empiric treatments. Ceftriaxone and levofloxacin were the most frequent ab; 69% of the 424 ab (non prophylactic) treatments were considered as adequate. 2.  Clinical failure was recognized in 110 cases (27%), microbiological failure in 49 (13%), relapse in 31 (8%) and death in 30 (7.5%). Factors associated to &quot;failure&quot; were and charlson score ?3 ( or 3.35, 95% ci 1.602-7.009); inadequate empirical treatment (or 5.68, 95%ci 2.898-11.217) and esbl producing e. Coli isolation (or 4.43 (95% ci 1.492-13.184). 3. In 1978, 46% of admitted patients included an ab in their treatments, 33% in 1982 and 49% in 2012 (p&lt;0.05 as for 1982 compared to 1978 or 2014). As for medical departments, ab prescription affected 37%, 47% and 59% of the patients, in 1978, 1982 and 2012 respectively (p&lt;0.05).  Rate of adequacy was 49%, 53% and 69% in the 3 different periods (p&lt;0.05 as for 2012 compared to 1978 or 1982); 35%, 32% and 21% of the patients received &gt;2 antibiotics in 1978, 1982 and 2012 respectively (p&lt;0.05 as for 2012 compared to 1978 or 1982). 4. A total of 316 questionnaires were completed; antibiotic dose, route of administration and treatment duration were always adjusted according to site of infection and underlying conditions in 65%, 68% and 45%, respectively. Antibiotic de-escalation was recognized as usual practice in 20%; 31% and 10% considers potential microbiological resistances and economical-cost when taking prescription decisions, respectively; 69% admits ab administration with probably no clinical indication. conclusions:  1. 49% of admitted patients received antibiotic treatment, being ceftriaxone and levofloxacin the most used antibiotic in therapeutic and amoxicilin\/ clavulanic in prophylactic. The choice of antibiotic was adequate in 68.9% with a 72.13% succes rate. 2. E.Coli esbl and \/ or r to ciprofloxacin; inadequate duration of antibiotic treatment and initial clinical severity is associated to clinical or microbiological failure and death. 3. Increasing higher rates of in-patients include an ab in their treatments, being monotherapy and prescription in medical departments more frequent in the recent cohort. The rate of adequacy is higher in 2012 than in previous cohorts, probably related to the implement of abpp 4. Answers of questionary shows the apparently limited knowledge of physicians so an antibiotic stewardship program is needed in our hospital<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Uso de antibioticos en el hospital clinico universitario virgen de la arrixaca 2012: estudio descriptivo, patrones de cambio (1978-1982-2012) e influencia del tratamiento antibiotico protocolizado en la evolucion de los pacientes con infecciones<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Uso de antibioticos en el hospital clinico universitario virgen de la arrixaca 2012: estudio descriptivo, patrones de cambio (1978-1982-2012) e influencia del tratamiento antibiotico protocolizado en la evolucion de los pacientes con infecciones <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Cristina Bonillo Garcia <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 04\/11\/2014<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Joaquin Gomez Gomez<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: melchor Alvarez de mon soto <\/li>\n<li>Mar\u00eda  del carmen Fari\u00f1as alvarez (vocal)<\/li>\n<li>Jos\u00e9 Barber\u00e1n l\u00f3pez (vocal)<\/li>\n<li>Mar\u00eda no Valdes chavarri (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Cristina Bonillo Garcia Objetivos: 1. Describir el uso de antibi\u00f3ticos en el hospital cl\u00ednico universitario virgen de [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[2193,1085,2445,8235],"tags":[230094,8322,144000,164002,8243,14431],"class_list":["post-116583","post","type-post","status-publish","format-standard","hentry","category-antibioticos","category-enfermedades-infecciosas","category-evaluacion-de-farmacos","category-murcia","tag-cristina-bonillo-garcia","tag-joaquin-gomez-gomez","tag-jose-barberan-lopez","tag-maria-del-carmen-farinas-alvarez","tag-maria-no-valdes-chavarri","tag-melchor-alvarez-de-mon-soto"],"_links":{"self":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/116583","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/comments?post=116583"}],"version-history":[{"count":0,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/116583\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/media?parent=116583"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/categories?post=116583"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/tags?post=116583"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}