Care Bundle: Strategies for Managing Antimicrobials in a Reference Transplant Hospital in Northeastern Brazil

Introduction: Infections by multidrug-resistant bacteria represent a serious public health problem, especially among transplant patients who, due to immunosuppression, become more susceptible to opportunistic infections and resistant pathogens. Antimicrobial Stewardship Programs (AMP) using care bundles have been implemented to promote the rational use of antibiotics and ensure care safety. Objectives: To evaluate the use of a care bundle in managing antimicrobial use in a transplant unit. Methods: This was an observational, descriptive, and retrospective study using data from the institutional AMP database. The antimicrobial management strategies employed between 2020, 2021, and 2023 were analyzed using a quantitative approach and statistical analysis. Results: A total of 398 patients were followed up, with 1,713 strategies recorded, of which 98.2% (n = 1,683) were accepted. The main strategy adopted was to reduce treatment time (30.8%). The most frequent treatment indications were bloodstream infection (47.2%) and upper respiratory tract infection (21.6%). Among the 1,390 antimicrobials monitored, 73.4% belonged to the therapeutic reserve category. Dose adjustment was associated with a 1.87-fold increase in the risk of death, a 5.37-fold increase in escalation, and a 2.33-fold increase in respiratory infections. Dose adjustment also increased treatment time by 10.4 days and hospitalization time by 13.4 days. Bloodstream infections, on the other hand, reduced treatment time by 9.5 days, which curiously increased hospitalization time by 5.2 days. Conclusion: The use of care bundles as part of AMP had a positive impact on the rational use of antimicrobials and relevant clinical outcomes, such as a reduction in the average length of stay and, consequently, exposure to antibiotics, with a possible reduction in resistance. However, mortality was associated with advanced age, the need for dose adjustment, escalation, and respiratory infections. Under-reporting and loss of data reinforce the need for digital technologies for real-time monitoring and continuous training of multi-professional teams