Percepção dos médicos veterinários em relação ao uso cosciente de antimicrobianos na conduta clínica-cirúrgica
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2021-08-17
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Universidade Estadual Paulista (Unesp)
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O uso racional de antimicrobianos envolve vários fatores para o seu sucesso e para que produza os resultados esperados, diminuindo riscos de resistência. A resistência antimicrobiana é preocupação mundial, trazendo prejuízos econômicos e malefícios à saúde. Este trabalho teve como objetivo avaliar a percepção e conduta de médicos veterinários cirurgiões no uso racional de antimicrobiano através de um estudo transversal de coleta de informações por formulário eletrônico (aplicativo Google Formulário) com perguntas que envolviam os conhecimentos básicos das classes bacterianas, conduta profilática e terapêutica nos casos abordados. Foram coletadas 400 respostas, quanto à aplicação de antimicrobiano, 69,5% (n=278), destacaram que deve ocorrer, entre 30 e 60 minutos antes da incisão cirúrgica. A prescrição de antimicrobiano no pós-cirúrgico, independentemente do tipo da cirurgia, aparece em 48,5% (n=194) enquanto, 51,5% (n=206) prescrevem apenas em cirurgias contaminadas e/ou sujas. Na cirurgia de ovariosalpingohisterectomia (OSH), 66,0% (n=264) prescrevem antimicrobiano pós-operatório, sendo a Amoxicilina com Clavulanato 25,7% (n=103), a mais prescrita. Em cirurgia com suspeita de peritonite advinda de ruptura intestinal, 67,0% (n=268), realizavam lavagem abdominal e coleta de material para cultura e antibiograma, 58,7% (n=235) já prescreviam o início de terapia profilática, antes do resultado da cultura e antibiograma. Foi correlacionado o grau de formação dos participantes, a partir dos dados estatísticos evidenciam achados relevantes e diferentes condutas. Especializados possuem tendência a prescrever antimicrobianos somente em cirurgias sujas ou contaminadas 55,0% (n=142), enquanto não especializados 45,8% (n=116). Especialistas realização com maior frequência os exames de cultura e antibiograma 63,2% (n=163) do que os não especialistas 41,5% (n=166). Em relação à administração de antibiótico no pré e trans cirúrgico, os não especializados apresentam tendência maior em não administrar 40,1% (n=57) do que especializados 16,7% (n=47). Sobre o momento de aplicação de um antimicrobiano profilático para evitar infecção de sítio cirúrgico 25,6% (n=66) dos especializados e 40,1% (n=57) dos não especializados indicam que deve ser feita em qualquer momento. Para uma OSH no pós cirúrgico 76,8% (n=109) dos não especializados e 59,7% (n=154) dos especializados prescrevem antimicrobianos. No caso de peritonite devido à ruptura de alça intestinal, 73,3% (n=189) dos especializados e 55,6% (n=79) dos não especializados coletam material para cultura e antibiograma. No estudo realizado não há consenso com relação ao uso da antibioticoterapia. A discussão, ensino, informação e exames para o diagnóstico da bactéria que está envolvida na infecção é importante. Medidas preventivas de infecção, como fiscalizar e sensibilizar sobre as questões sanitárias em clínicas e hospitais veterinários, da esterilização dos materiais cirúrgicos, da antissepsia do cirurgião e do paciente, pode diminuir o uso de antibióticos colaborando para retardar o surgimento de bactérias multirresistentes.
The rational use of antimicrobials involves several factors for its success and for it to produce the expected results, reducing resistance risks. Antimicrobial resistance is a global concern, bringing economic damage and harm to health. This study aimed to evaluate the perception and conduct of surgeons veterinarians in the rational use of antimicrobials through a cross-sectional study of information collection by electronic form (Google Form application) with questions involving basic knowledge of bacterial classes, prophylactic and therapeutic in the cases discussed. 400 responses were collected regarding the application of antimicrobials, 69.5% (n=278) highlighted that it should occur between 30 and 60 minutes before the surgical incision. The prescription of antimicrobials in the post-surgery period, regardless of the type of surgery, appears in 48.5% (n=194) while 51.5% (n=206) prescribe it only in contaminated and/or dirty surgeries. In ovariosalpingohysterectomy (OSH) surgery, 66.0% (n=264) prescribe postoperative antimicrobials, with Amoxicillin with Clavulanate 25.7% (n=103) being the most prescribed. In surgery with suspected peritonitis arising from intestinal rupture, 67.0% (n=268) performed abdominal lavage and collection of material for culture and antibiogram, 58.7% (n=235) already prescribed the start of prophylactic therapy, before the result of the culture and antibiogram. The degree of education of the participants was correlated, based on statistical data that show relevant findings and different approaches. Specialized professionals tend to prescribe antimicrobials only in dirty or contaminated surgeries 55.0% (n=142), while non-specialized 45.8% (n=116). Specialists perform more frequently the culture and antibiogram exams 63.2% (n=163) than non-specialists 41.5% (n=166). Regarding the administration of antibiotics before and during surgery, non-specialized patients showed a greater tendency not to administer 40.1% (n=57) than specialized 16.7% (n=47). Regarding the moment of application of a prophylactic antimicrobial to prevent surgical site infection, 25.6% (n=66) of the specialized and 40.1% (n=57) of the non-specialized indicate that it should be done at any time. For a postoperative OSH, 76.8% (n=109) of non-specialized and 59.7% (n=154) of specialized prescribe antimicrobials. In the case of peritonitis due to rupture of the intestinal loop, 73.3% (n=189) of the specialized and 55.6% (n=79) of the nonspecialized collect material for culture and antibiogram. In the study performed, there is no consensus regarding the use of antibiotic therapy. Discussion, teaching, information and tests for the diagnosis of the bacteria that are involved in the infection is important. Preventive measures for infection, such as monitoring and raising awareness about health issues in veterinary clinics and hospitals, sterilization of surgical materials, antisepsis for the surgeon and the patient, can reduce the use of antibiotics, helping to delay the emergence of multiresistant bacteria.
The rational use of antimicrobials involves several factors for its success and for it to produce the expected results, reducing resistance risks. Antimicrobial resistance is a global concern, bringing economic damage and harm to health. This study aimed to evaluate the perception and conduct of surgeons veterinarians in the rational use of antimicrobials through a cross-sectional study of information collection by electronic form (Google Form application) with questions involving basic knowledge of bacterial classes, prophylactic and therapeutic in the cases discussed. 400 responses were collected regarding the application of antimicrobials, 69.5% (n=278) highlighted that it should occur between 30 and 60 minutes before the surgical incision. The prescription of antimicrobials in the post-surgery period, regardless of the type of surgery, appears in 48.5% (n=194) while 51.5% (n=206) prescribe it only in contaminated and/or dirty surgeries. In ovariosalpingohysterectomy (OSH) surgery, 66.0% (n=264) prescribe postoperative antimicrobials, with Amoxicillin with Clavulanate 25.7% (n=103) being the most prescribed. In surgery with suspected peritonitis arising from intestinal rupture, 67.0% (n=268) performed abdominal lavage and collection of material for culture and antibiogram, 58.7% (n=235) already prescribed the start of prophylactic therapy, before the result of the culture and antibiogram. The degree of education of the participants was correlated, based on statistical data that show relevant findings and different approaches. Specialized professionals tend to prescribe antimicrobials only in dirty or contaminated surgeries 55.0% (n=142), while non-specialized 45.8% (n=116). Specialists perform more frequently the culture and antibiogram exams 63.2% (n=163) than non-specialists 41.5% (n=166). Regarding the administration of antibiotics before and during surgery, non-specialized patients showed a greater tendency not to administer 40.1% (n=57) than specialized 16.7% (n=47). Regarding the moment of application of a prophylactic antimicrobial to prevent surgical site infection, 25.6% (n=66) of the specialized and 40.1% (n=57) of the non-specialized indicate that it should be done at any time. For a postoperative OSH, 76.8% (n=109) of non-specialized and 59.7% (n=154) of specialized prescribe antimicrobials. In the case of peritonitis due to rupture of the intestinal loop, 73.3% (n=189) of the specialized and 55.6% (n=79) of the nonspecialized collect material for culture and antibiogram. In the study performed, there is no consensus regarding the use of antibiotic therapy. Discussion, teaching, information and tests for the diagnosis of the bacteria that are involved in the infection is important. Preventive measures for infection, such as monitoring and raising awareness about health issues in veterinary clinics and hospitals, sterilization of surgical materials, antisepsis for the surgeon and the patient, can reduce the use of antibiotics, helping to delay the emergence of multiresistant bacteria.
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Cirurgia veterinaria, Assepsia e antissepsia cirurgica, Anti-infecciosos, Farmacorresistência bacteriana