Critérios para descalonamento de antimicrobianos em ambiente hospitalar: revisãointegrativa

Abstract

In a scenario of high antibiotic consumption, antimicrobial resistance becomes a significant problem. Antibiotic de-escalation is a strategy developed to optimize antimicrobial choice and reduce unnecessary exposure time. However, identifying precise criteria to guide you is challenging. In this context, this study aimed to provide an updated overview of existing knowledge about the criteria used for antibiotic de-escalation. To this end, an integrative review of the literature indexed in the MEDLINE (via PubMed) and SciELO databases was carried out, considering works published between 2019 and 2023, in Portuguese, English and Spanish. The search in the PubMed database resulted in 707 publications, while SciELO returned no results. After reading the titles and abstracts, 665 publications were excluded, leaving 42 articles for full reading, of which 21 were selected for review. The concept of antimicrobial de-escalation generally involves replacing broad-spectrum antibiotics with others with a narrower spectrum, modifying the initial regimen, or reducing treatment time. Although there are no validated protocols, there is consensus on the use of Rapid Diagnostic Tests (RDT) and Antimicrobial Sensitivity Tests (AST), prescription review by multidisciplinary teams, measurement of biomarkers such as Procalcitonin and C-Reactive Protein, and monitoring of clinical parameters. RDT and TSA are essential for quickly identifying pathogens and resistance profiles. Institutional protocols and prescription audits ensure appropriate use of antimicrobials, and integration of these strategies is crucial to combating antimicrobial resistance.