ANALYSIS OF DATA ON ANTIMICROBIAL USE AND THE OCCURRENCE OF ACUTE RENAL INJURY IN PATIENTS ADMITTED TO A HOSPITAL IN WESTERN PARÁ, BRAZIL

Description

In hospital units, the evaluation and pharmaceutical follow-up of medical prescriptions is an important source for pharmaceutical care and pharmaceutical clinical services (BATISTA, 2014; BERNARDI et al., 2014). One common problem that has high hospital incidence rates is the occurrence of acute kidney injury (AKI) (MELLO et al., 2021). Pharmacovigilance among other activities is implemented in hospitals for the purpose of receiving and monitoring reports of adverse effects related to medications administered to patients (PEZATO et al., 2015). The survey evaluated the incidence of acute kidney injury in patients hospitalized and exposed to antimicrobials in a public hospital in the state of Pará, Brazil. A prospective and observational cohort was carried out, whose outcome of interest is the occurrence of AKI in patients admitted to the hospital between October 2018 and January 2019. The data were recorded and stored in a database, then descriptive analysis was performed in the GraphPad Prism 6.0 program. Quantitative variables were expressed as standard deviation (SD) of the mean and the number of cases as a percentage. We collected data from 70 patients who were admitted to the hospital and needed to use any of the antimicrobials selected in the observation period during hospital treatment. The survey results showed that mostly male (64.29%; n = 45). Age ranged from 19 to 96 years, with a mean of 52.49 years (SD = 20.31). The patients included were mostly from the oncology clinic (34.29%; n = 24) those that had had surgery (27.14%; n = 19). Most critically ill patients admitted to the adult ICU (26.47 %; n = 9) developed AKI. Regarding the number of medications used by patients, there was a variation from 5 to 17, with a mean of 10.26 (SD = 2.90) medications prescribed per patient. In the data regarding the antimicrobials, most patients took ceftriaxone (n = 29), cefepime (n = 27) and piperacillin/tazobactam (n = 23). In terms of the number of antimicrobials prescribed per patient, 60% (n = 42) of patients took only one, 30% (n = 21) took two and 10% (n = 7) took three or more antimicrobials for treatment of infections. The plasma concentrations of vancomycin ranged from 3.0 μg/mL to 22.5 μg/mL. Of the 10 samples collected, 10.0% (n = 1) were above the therapeutic range established by the literature (between 10 to 20 µg/mL), 30.0% (n = 3) were within the reference values and 60.0% (n = 6) of the patients had values below the reference values. Patients who developed AKI (60.0%; n = 6) during vancomycin use had concentration values between 3 µg/mL and 15.9 µg/mL, most of whom had values below the recommended therapeutic range. Of these patients with AKI, 83.33% (n = 5) used more than one nephrotoxic antimicrobial during hospital treatment. The concentrations of patients who were not diagnosed with AKI (40.0%; n = 4) ranged from 3.0 µg/mL to 22.5 µg/mL.

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The research was developed using a prospective and observational cohort whose outcome of interest is the occurrence of AKI in patients admitted to a public hospital in the city of Santarém, state of Pará, Brazil, from October 2018 to January 2019, totaling 90 days of data collection. The study included patients aged 18 years or over, who had no history or any record of kidney disease at the time of admission, who were being treated with at least one of the antimicrobials with potential for nephrotoxicity and who had been on treatment for at least at least five days with these medications and at least two laboratory tests that occurred during treatment. The most used antimicrobials were classified according to the treatment authorization spreadsheet from the hospital infection control committee (CCIH) and through the monthly consumption presented by the hospital management software (Tazy); these being amikacin, amphotericin B, cefepime, ceftriaxone, ciprofloxacin, gentamicin, piperacillin/tazobactam and vancomycin. Patients under 18 years of age, with antimicrobial treatment of less than five days, those who underwent less than two laboratory tests during treatment and those with a history or any record of kidney disease, whether or not undergoing renal replacement therapy, were excluded from the study. the study. The incidence of AKI cases was determined by applying the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, where: SCr ≥ 1.5 times greater than baseline, known or presumed to have occurred within one week and/or SCr ≥ 0.3 mg/dL (26 µmol/L) over a period of 48 hours. For cases that met the diagnostic criteria, the following KDIGO group criteria were applied: when a variation in SCr occurred and was equal to or greater than 1.5x baseline SCr, but less than 2x baseline SCr, known or presumed to have occurred within the last 7 days and/or CrS ≥ 0.3 mg/dL (26 µmol/L) within 48 hours, corresponds to stage I; a variation in SCr equal to or greater than 2x baseline SCr, but less than 3x baseline SCr, this corresponds to stage II; a variation in SCr equal to or greater than 3x the baseline SCr or an increase in SCr to ≥ 4.0 mg/dL (354 µmol/L) or initiation of renal replacement therapy, this corresponds to stage III. The data were recorded and stored in a database, and the analysis was descriptive and carried out using the GraphPad Prism 6.0 program. Quantitative variables were expressed as mean (SD) and as a percentage of the number of cases (%).

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