Antimicrobial consumption, costs and resistance patterns: a two year prospective study in a Romanian intensive care unit
| Autor: | Marius Papurica, Ovidiu Horea Bedreag, Luminita Baditoiu, Dorel Sandesc, Mirela Voicu, Delia Muntean, Carmen Axente, Dorina Dugaesescu, Florin George Horhat, Monica Licker, Roxana Moldovan, Elena Hogea |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Male Pediatrics Antibiotics MRSA medicine.disease_cause law.invention 0302 clinical medicine Anti-Infective Agents law Drug Resistance Multiple Bacterial Medicine 030212 general & internal medicine Prospective Studies Prospective cohort study Cross Infection Incidence (epidemiology) Middle Aged Staphylococcal Infections Antimicrobial Intensive care unit Anti-Bacterial Agents Community-Acquired Infections Intensive Care Units Infectious Diseases Staphylococcus aureus Chemoprophylaxis Preoperative Period Female Research Article DDD Methicillin-Resistant Staphylococcus aureus medicine.medical_specialty medicine.drug_class 030106 microbiology Microbial Sensitivity Tests beta-Lactamases lcsh:Infectious and parasitic diseases 03 medical and health sciences Internal medicine Humans lcsh:RC109-216 business.industry Romania Antibiotic Perioperative Antibiotic Prophylaxis Klebsiella Infections ESBL ICU business |
| Zdroj: | BMC Infectious Diseases BMC Infectious Diseases, Vol 17, Iss 1, Pp 1-9 (2017) |
| ISSN: | 1471-2334 |
| Popis: | Background Due to the vulnerable nature of its patients, the wide use of invasive devices and broad-spectrum antimicrobials used, the intensive care unit (ICU) is often called the epicentre of infections. In the present study, we quantified the burden of hospital acquired pathology in a Romanian university hospital ICU, represented by antimicrobial agents consumption, costs and local resistance patterns, in order to identify multimodal interventional strategies. Methods Between 1 st January 2012 and 31 st December 2013, a prospective study was conducted in the largest ICU of Western Romania. The study group was divided into four sub-samples: patients who only received prophylactic antibiotherapy, those with community-acquired infections, patients who developed hospital acquired infections and patients with community acquired infections complicated by hospital-acquired infections. The statistical analysis was performed using the EpiInfo version 3.5.4 and SPSS version 20. Results A total of 1596 subjects were enrolled in the study and the recorded consumption of antimicrobial agents was 1172.40 DDD/ 1000 patient-days. The presence of hospital acquired infections doubled the length of stay (6.70 days for patients with community-acquired infections versus 16.06/14.08 days for those with hospital-acquired infections), the number of antimicrobial treatment days (5.47 in sub-sample II versus 11.18/12.13 in sub-samples III/IV) and they increased by 4 times compared to uninfected patients. The perioperative prophylactic antibiotic treatment had an average length duration of 2.78 while the empirical antimicrobial therapy was 3.96 days in sample II and 4.75/4.85 days for the patients with hospital-acquired infections. The incidence density of resistant strains was 8.27/1000 patient-days for methicilin resistant Staphylococcus aureus , 7.88 for extended spectrum β-lactamase producing Klebsiella pneumoniae and 4.68/1000 patient-days for multidrug resistant Acinetobacter baumannii. Conclusions Some of the most important circumstances collectively contributing to increasing the consumption of antimicrobials and high incidence densities of multidrug-resistant bacteria in the studied ICU, are represented by prolonged chemoprophylaxis and empirical treatment and also by not applying the definitive antimicrobial therapy, especially in patients with favourable evolution under empirical antibiotic treatment. The present data should represent convincing evidence for policy changes in the antibiotic therapy. |
| Databáze: | OpenAIRE |
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