Technological optimization of antibiotic use

The inappropriate use of antibiotics in underdeveloped countries is difficult, because we do not have software to receive information from the patient and subsequently control (access or limit) its use; it is planned to introduce a database of the cultures carried out, sample, sensitivity, resistance to predict this solution.

The team from the Private University of the Valle of Cochabamba Bolivia is composed of Dr. Rommer Alex Ortega Martinez and Eynar Calle Viles (Research Coordinators).

The inappropriate use of antibiotics in hospitals generate many deaths and high costs, especially in underdeveloped countries; infections caused by resistant bacteria are responsible for the death of 700,000 people each year worldwide; of further concern is the fact that 40 % of the health burden of this situation is caused by bacteria resistant to last resort antibiotics (carbapenems, colistin); 700 thousand cases of antimicrobial resistance (AMR) have been registered, more than those of cancer, cholera, diabetes and diarrhea. The World Health Organization (WHO) indicates: “no action today, no cure tomorrow”, therefore AMR will cause 10 million deaths per year by 2050 and a reduction of 2 and 5% of the gross domestic product. A study by the University of Oxford concluded that in Latin America 569 thousand deaths could be related to AMR, and of these, 141 thousand were attributable to this phenomenon, that is, 11.1 % of all deaths attributable to AMR occurred in America. One of the most important causes is the lack of an antibiotic restriction system in underdeveloped countries and also the insecurity of health personnel. For this purpose, it is estimated to create local software for optimal use of antibiotics with local databases.

The technological optimization of the use of antibiotics in underdeveloped countries (TOUA), is aimed at health personnel in general, however, with more emphasis on pharmacy personnel, infectious disease service, hospitalization and intensive care doctors, but of course it is fully aimed at our patients to prevent serious infections, through optimal use of antibiotics. Basically, what is required for its operation is coordinated work with biomedical engineers, statisticians, etc. For the creation of the medical software, the same professionals as the Universidad Privada del Valle de Cochabamba Bolivia have. Undoubtedly, the team at our institution has the capacity to achieve this objective, knowing the urgent needs for antibiotic control in our department.

Taking into account the public good that this proposal can generate, it is initially focused on benefiting the patient, especially to quickly reduce mortality in patients who have resistance to antibiotics and of course on the success of patients with infectious pathology. On the other hand, taking into account the database that will be used, with information on microbiological results, antibiotics, sensitivity and resistance, an infinite number of research works can be developed, completely salvageable for high-impact journals.

This proposal as a solution to the problem of antimicrobial resistance will reduce the mortality of patients with infectious pathology, provide a better prognosis at the time of admission, so the patient would be the first to benefit; In another order of ideas, we cannot fail to mention the health personnel who developed a new perspective in the management of antibiotics, taking optimal care of their use; Unfortunately, patients are susceptible to innumerable complications during their hospitalization, inherent to their pathology, idiosyncrasy, economic-social factors and others; Therefore, if the problem of AMR is reduced or eliminated, there will be better health results. The implementation of a PROA is widely accepted in a hospital environment, reducing the consumption of antimicrobials, without compromising patient safety (https://doi.org/10.37201%2Freq%2F142.2022), which can be worked with the application or software to determine the indication or not of antibiotics.

The coverage of the software for the technological optimization of the use of antibiotics in underdeveloped countries (TOUA) allows it to reach, in the first instance, hospitals in the city of Cochabamba-Cercado, both public and private, and in this way reach coverage between 80 and 90 %. of the institutions; next, depending on the health, economic and social impact, it is intended to cover more hospitals in the other departments of Bolivia and in this way create a network to control the optimal use of antibiotics, where health professionals, statisticians, epidemiologists and health professionals will participate, without There is no doubt that this could take from 6 months to more than two years, focusing on the sum of data so that the predictive model is much more sensitive.

Basically what is intended to be done is to take the microbiological data from the Hospital Obrero No. 2 of the National Health Fund (Social Security), with the corresponding permits and in this way upload them to the software, in addition to some patient data; with the results and through predictive models, we hope to structure and perfect it, to begin using it with patients who enter the institution, for approximately 2 months; this testing stage is essential to begin reaching the Univalle Norte and Sud Hospitals, owned by the university, where they will also apply the software for another two months. With a greater number of patients in the software and better predictive models, it will be evaluated in detail. the benefit until that moment, taking into account the following points:

1. The opinion and inclination of the users (health personnel), evaluating its accessibility, effectiveness, relevance and, above all, damages to the work already known.

2. Carry out an analysis of the economic impact generated by the use of the software (before and after the start of the software application).

3. Observe the clinical evolution of the patients, hospital stay and mortality after applying the software.

The most tangible barriers or limitations in the implementation of this software revolve around the inclination of different hospitals, health personnel and others, knowing that until now there is no system or network that adequately controls the rational use of antibiotics. The mentality of many professionals can impede its progress, and the reflection of hospital infections in each institution can become a health susceptibility. In this way, it is planned to implement institutional and departmental talks to reflect the importance of good control of infections and other complications due to the misuse of antibiotics; From another perspective, the participation of departmental authorities, knowing the economic impact, will be essential to overcome these limitations.

As an educational and research institution and also because of the experience i have as a team leader in hospital-acquired infections and resistance to antibiotics, especially in critically ill patients, we see it pertinent to apply in this global problem, where all countries present difficulties and, above all, all bad health outcomes. Being an underdeveloped country, we see it necessary to create this software that in the future will become an antibiotic control network, where internists, intensivists, clinicians, infectious disease specialists, biochemists and pharmacists, nurses, health and municipal or government authorities will participate.

Basically, what would interest us is to be able to enter the health institutions that we mentioned, without objections, since thanks to them we will be able to enrich this solution and in the immediate future see the benefits of this software, generate changes, extensions, talks and dissemination of the same.

Through an institutional email from the Universidad Privada del Valle in Cochabamba Bolivia.