Tratamentos antimicrobianos em pacientes pediátricos, antes, durante e após hospitalização: uma coorte prospectiva

Abstract

INTRODUCTION: Describe the antimicrobial treatments used in the pediatric context is a great opportunity to identify and fix assistance’s gaps or failures during antimicrobial use and then treat appropriately bacterial infections with clinical successful, cost reduced and decreased bacterial resistance in the childhood. AIMS: Describe the antimicrobial treatments used in children upon admission, hospitalization, discharge and outpatient follow-up in a pediatric ward. METHODS: Cohort study with patients aged 3 months and above in antimicrobial therapeutic use upon admission, hospitalization, discharge and outpatient follow-up, in the pediatric ward of the Federal University of Bahia Hospital. Collected data included date of birth, date of admission, sex, complaints and signs on admission, diagnosis of infection, prescribed antimicrobial before and upon hospitalization. RESULTS: The most frequent complaints were fever (n=157; 75.1%), vomiting (n=51; 24.4%), hyporexia (n=42; 20.1%), abdominal pain (n=35; 16.7%), and diarrhea (n=34; 16.3%). The most frequent diagnoses were cellulitis (n=44; 21.0%), urinary tract infection (n=38; 18.2%), fever without localizing signs (n=20; 9.6%), lymphadenitis (n=18; 8.6%), and gastroenteritis (n=15; 7.2%). The most antibiotics were ceftriaxone (n=141; 67.5%), oxacillin (n=52; 24.9%), metronidazole (n=15; 7.2%), amoxicillin-clavulanate (n=8; 3.8%), and clindamycin (n=8; 3.8%). Overall, of these 209 patients in this study, 44 (21.1%) had their antimicrobials withdrawn upon admission due to excluded bacterial infection while 78 (37.3%) changed and antimicrobials were de-escalated upon admission (n=48), once (n=17) and twice (n=5) respectively during hospital stay, and even the 87 (41.6%) whose had the same antimicrobials kept antimicrobials were de-escalated once (n=19) and twice (n=2) upon hospitalization. Furthermore, the median of age in the three patients subgroups in month were 30.5 (11-91.7), 62 (27.7-106) e 39 (20-108), respectively. All patients were hospital discharged and finished attended outpatient follow-up visit after clinical improvement. CONCLUSION: The stopped of antimicrobials, change and de-escalation by pediatricians according diagnoses and patient evolution can contributed to avoid antimicrobial overuse in the pediatric context and always should be encouraged.