Assessment of an intervention aimed at early discontinuation of intravenous antimicrobial therapy in a Brazilian University hospital

Antibiotic use in the treatment of respiratory tract infections is common in primary care. The European Surveillance of Antimicrobial Consumption (ESAC programme), collecting data from 35 countries, showed that antibiotic use was highest in southern European countries. Increased antibiotic consumption has been shown by numerous ecological studies to contribute to the emergence of antibiotic resistance in streptococci. A study comparing outpatient antibiotic consumption in the USA showed it to be similar to that in southern European countries, but macrolides, particularly azithromycin, are among the first-line agents prescribed in the USA for respiratory infections. In Europe, patients are more likely to receive a beta-lactam; and when a macrolide is indicated, clarithromycin is more likely to be prescribed than azithromycin. Streptococci resistance to macrolides can be acquired via two mechanisms: by the mef gene, which encodes for the efflux pump mechanism, producing low to moderate resistance, or the erm gene (post-transcriptional modification of the bacterial ribosomal unit), resulting in high resistance. Macrolide resistance is mediated by erm(B) and mef(A) alone or in combination. A surveillance study showed that mef was responsible for most of the macrolide resistance seen in the USA; a decrease in the number of isolates carrying mef(A) was associated with a doubling of the number of isolates carrying both mef(A) and erm(B). Higher consumption of clarithromycin in Europe correlated with a predominance of erm(B)-carrying Streptococcus pneumoniae. The erm(B) gene caused resistance in 84% of the isolates in Europe.

Background While significant strides have been made in health research, the incorporation of research evidence into healthcare decision-making has been marginal. The purpose of this paper is to provide an overview of how the utility of health services research can be improved through the use of theory. Integrating theory into health services research can improve research methodology and encourage stronger collaboration with decision-makers. Discussion Recognizing the importance of theory calls for new expectations in the practice of health services research. These include: the formation of interdisciplinary research teams; broadening the training for those who will practice health services research; and supportive organizational conditions that promote collaboration between researchers and decision makers. Further, funding bodies can provide a significant role in guiding and supporting the use of theory in the practice of health services research. Summary Institutions and researchers should incorporate the use of theory if health services research is to fulfill its potential for improving the delivery of health care.