Use of antibiotics by hospitalized elderly and changes in serum creatinine
DOI: 10.15343/0104-7809.202044126133
Keywords:
Aged; Anti-Bacterial Agents; Prescriptions; Creatinine; Renal Insufficiency.Abstract
The rapid growth of the elderly population, associated with longer life expectancy, is associated with a higher prevalence
of chronic non-communicable diseases, such as those of the cardiovascular, renal system and neoplasms. A large portion
of these pathologies require hospitalization and their conditions require the use of antibiotics (ATB), whose indiscriminate
use can lead to Acute Kidney Injury (AKI), which has serum creatinine as one of its markers. Therefore, the present study
aimed to evaluate changes in serum creatinine of hospitalized elderly people submitted to antibiotic therapy in a university
hospital. This was a cross-sectional study in which patients over 60 years old were identified during a period of 6 months
and who used ATB, as well as had their serum creatinine measured. The variables age, gender, length of hospital stays and
use of ATB were considered, as well as serum creatinine values before and after antibiotic therapy. A total of 796 patients
participated in the study, 51.4% (409) of whom were male. Ages ranged from 60 to 109 years, with an average of 74.9 (±
9.6). It was identified that length of stay and use of ATB are variables that interfere with the increase in creatinine due to
antibiotic therapy, which was observed in 75.5% of the patients. This leads to the reflection about a possible indiscriminate
prescription of antimicrobials and their correlation to AKI.
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References
Rev Ciênc Farm Básica Apl. 2012;25;32(3):305-11.
2. Aguiar PM, Lyra Junior DP, Silva DT, Marques TC. Avaliação da farmacoterapia de idosos residentes em instituições asilares no nordeste do Brasil.
Lat Am J Pharm. 2008;27(3):454-9.
3. Rodrigues FD, Bertoldi AD. Perfil da utilização de antimicrobianos em um hospital privado. Cien Saude Colet. 2010;15(1):1239-47.
4. Baldea AJ. Effect of aging on renal function plus monitoring and support. Surg Clin N Am. 2015;95(1):71-83.
5. Correa L. Restrição do uso de antimicrobianos no ambiente hospitalar. Crit Care Med. 2001;29(6):1109-5.26.
6. Castellar JI, Karnikowski MG, Vianna LG, Nóbrega OD. Estudo da farmacoterapia prescrita a idosos em instituição brasileira de longa permanência.
Acta Medica Port. 2007;20(3):97-105.
7. Costa JM, Martins JM, Pedroso LA, Braz CL, Reis AM. Otimização dos cuidados farmacêuticos na alta hospitalar: implantação de um serviço de
orientação e referenciamento farmacoterapêutico. Rev Bras Farm Hosp Serv Saúde. 2014;5(1):38-41.
8. Mizoi CS, Dezoti C, Vattimo MD. Função renal de pacientes de unidade de terapia intensiva: creatinina plasmática e proteína carreadora do retinol
urinário. Rev Bras Tera Intensiva. 2010;20(4):385-93.
9. Rosa MB, Reis AM, Lima CR. A Farmácia e o controle das infecções hospitalares. Gomes MJVM, Reis AMM, organizadores. Ciências farmacêuticas:
uma abordagem em farmácia hospitalar. 1ª ed. São Paulo: Atheneu. 2003:407-27.
10. Raveh D, Levy Y, Schlesinger Y, Greenberg A, Rudensky B, Yinnon AM. Longitudinal surveillance of antibiotic use in the hospital. Qjm.
2001;94(3):141-52.
11. Roque KE, Tonini T, Melo EC. Eventos adversos na unidade de terapia intensiva: impacto na mortalidade e no tempo de internação em um estudo
prospectivo. Cad Saude Publica. 2016;32(10):1-15.
12. Louro E, Romano-Lieber NS, Ribeiro E. Adverse events to antibiotics in inpatients of a university hospital. Rev saude publica. 2007;41(6):1042-8.
13. Moreira IP, Amado LE, Bersani AL, Bersani-Amado CA, Caparroz-Assef SM. Principais aspectos do tratamento das infecções no idoso. Ciênc Cuid
Saude. 2007;6(2):488-95.
14. Sodré FL, Costa JC, Lima JC. Avaliação da função e da lesão renal: um desafio laboratorial. J Bras Patol Med Lab.2007;43(5):329-37.
15. Marin MJ, Cecílio LC, Perez AE, Santella F, Silva CB, Gonçalves Filho JR, Roceti LC. Caracterização do uso de medicamentos entre idosos de uma
unidade do Programa Saúde da Família. Cad Saude Publica. 2008;24(3):1545-55.
16. Babuin L, Jaffe AS. Troponin: the biomarker of choice for the detection of cardiac injury. Cmaj. 2005;8;173(10):1191-202.
17. Schrezenmeier EV, Barasch J, Budde K, Westhoff T, Schmidt‐Ott KM. Biomarkers in acute kidney injury–pathophysiological basis and clinical
performance. Acta Physiol. 2017;219(3):556-74.
18. Teo SH, Endre ZH. Biomarkers in acute kidney injury (AKI). Best Pract Res Clin Anaesthesiol. 2017;1;31(3):331-44.
19. Waikar SS, Betensky RA, Bonventre JV. Creatinine as the gold standard for kidney injury biomarker studies?. Nephrol Dial Transpl. 2009;24(11):3263-
5
20. Wasung ME, Chawla LS, Madero M. Biomarkers of renal function, which and when?. Clin Chim Acta.. 2015.1;438(2):350-7.
21. Peres LA, Cunha Júnior AD, Schäfer AJ, Silva AL, Gaspar AD, Scarpari DF, Alves JB, Girelli Neto R, Oliveira TF. Biomarkers of acute kidney injury. J
Bras Nefrol. 2013;35(3):229-36.
22. Kusumota L, Rodrigues RA, Marques S. Idosos com insuficiência renal crônica: alterações do estado de saúde. Rev Lat-Am Enferm. 2004;12(3):525-
532.
23. Passarelli MC, Jacob Filho W. Reações adversas a medicamentos em idosos: como prevê-las. Einstein. 2007;5(3):246-51.
24. Falagas ME, Rizos M, Bliziotis IA, Rellos K, Kasiakou SK, Michalopoulos A. Toxicity after prolonged (more than four weeks) administration of
intravenous colistin. BMC Infec Dis. 2005;5(1):1.
25. Passarelli MC. Reações adversas a medicamentos em uma população idosa hospitalizada [tese]. São Paulo: Faculdade de Medicina; 2005.
26. Falagas ME, Rafailidis PI, Kasiakou SK, Hatzopoulou P, Michalopoulos A. Effectiveness and nephrotoxicity of colistin monotherapy vs. colistin–
meropenem combination therapy for multidrug-resistant Gram-negative bacterial infections. Clin Microbiol. Infect. 2006;12(12):1227-30.
27. Gomes DM, Smotherman C, Birch A, Dupree L, Della Vecchia BJ, Kraemer DF, Jankowski CA. Comparison of acute kidney injury during treatment
with vancomycin in combination with piperacillin‐tazobactam or cefepime. Pharmacotherapy. 2014;34(7):662-9.
28. Kubin CJ, Ellman TM, Phadke V, Haynes LJ, Calfee DP, Yin MT. Incidence and predictors of acute kidney injury associated with intravenous
polymyxin B therapy. J Infection. 2012 ;65(1):80-7.
29. Maldonado F, Llanos-Zavalaga F, Mayca J. Uso y prescripción de medicamentos antimicrobianos en el Hospital de Apoyo de la Merced-Perú. Rev
Peru Med Exp Salud Publica. 2002;19(4):181-5.
30. Dalton RN. Creatinina sérica e taxa de filtração glomerular: percepção e realidade. J Bras Patol Med Lab. 2011;47(1):8-11.
31. Bastos MG, Kirsztajn GM. Chronic kidney disease: importance of early diagnosis, immediate referral and structured interdisciplinary approach to
improve outcomes in patients not yet on dialysis. J Bras Nefrol. 2011;33(1):93-108.
32. Saraiva IH, Jones RN, Erwin M, Sader HS. Avaliação da sensibilidade a antimicrobianos de 87 amostras clínicas de enterococos resistentes à
vancomicina. Rev Assoc Med Bras. 1997;43(3): 217-222.