Antimicrobial consumption, costs and resistance patterns: a two year prospective study in a Romanian intensive care unit
Abstract 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 Rom...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-05-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12879-017-2440-7 |
| _version_ | 1828854481348984832 |
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| author | Carmen Axente Monica Licker Roxana Moldovan Elena Hogea Delia Muntean Florin Horhat Ovidiu Bedreag Dorel Sandesc Marius Papurica Dorina Dugaesescu Mirela Voicu Luminita Baditoiu |
| author_facet | Carmen Axente Monica Licker Roxana Moldovan Elena Hogea Delia Muntean Florin Horhat Ovidiu Bedreag Dorel Sandesc Marius Papurica Dorina Dugaesescu Mirela Voicu Luminita Baditoiu |
| author_sort | Carmen Axente |
| collection | DOAJ |
| description | Abstract 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 1st January 2012 and 31st 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. |
| first_indexed | 2024-12-13T00:33:47Z |
| format | Article |
| id | doaj.art-e4ed54d36cd746238cf5ab7a00e5a021 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-13T00:33:47Z |
| publishDate | 2017-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-e4ed54d36cd746238cf5ab7a00e5a0212022-12-22T00:05:15ZengBMCBMC Infectious Diseases1471-23342017-05-011711910.1186/s12879-017-2440-7Antimicrobial consumption, costs and resistance patterns: a two year prospective study in a Romanian intensive care unitCarmen Axente0Monica Licker1Roxana Moldovan2Elena Hogea3Delia Muntean4Florin Horhat5Ovidiu Bedreag6Dorel Sandesc7Marius Papurica8Dorina Dugaesescu9Mirela Voicu10Luminita Baditoiu11Microbiology Department, “Victor Babeş” University of Medicine and PharmacyMicrobiology Department, “Victor Babeş” University of Medicine and PharmacyMicrobiology Department, “Victor Babeş” University of Medicine and PharmacyMicrobiology Department, “Victor Babeş” University of Medicine and PharmacyMicrobiology Department, “Victor Babeş” University of Medicine and PharmacyMicrobiology Department, “Victor Babeş” University of Medicine and PharmacyPius Branzeu” Emergency Clinical County HospitalPius Branzeu” Emergency Clinical County HospitalPius Branzeu” Emergency Clinical County HospitalMicrobiology Department, “Victor Babeş” University of Medicine and PharmacyPharmacology and Clinical Pharmacy Department, “Victor Babeş” University of Medicine and PharmacyEpidemiology Department, “Victor Babeş” University of Medicine and PharmacyAbstract 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 1st January 2012 and 31st 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.http://link.springer.com/article/10.1186/s12879-017-2440-7ICUAntibioticDDDESBLMRSA |
| spellingShingle | Carmen Axente Monica Licker Roxana Moldovan Elena Hogea Delia Muntean Florin Horhat Ovidiu Bedreag Dorel Sandesc Marius Papurica Dorina Dugaesescu Mirela Voicu Luminita Baditoiu Antimicrobial consumption, costs and resistance patterns: a two year prospective study in a Romanian intensive care unit BMC Infectious Diseases ICU Antibiotic DDD ESBL MRSA |
| title | Antimicrobial consumption, costs and resistance patterns: a two year prospective study in a Romanian intensive care unit |
| title_full | Antimicrobial consumption, costs and resistance patterns: a two year prospective study in a Romanian intensive care unit |
| title_fullStr | Antimicrobial consumption, costs and resistance patterns: a two year prospective study in a Romanian intensive care unit |
| title_full_unstemmed | Antimicrobial consumption, costs and resistance patterns: a two year prospective study in a Romanian intensive care unit |
| title_short | Antimicrobial consumption, costs and resistance patterns: a two year prospective study in a Romanian intensive care unit |
| title_sort | antimicrobial consumption costs and resistance patterns a two year prospective study in a romanian intensive care unit |
| topic | ICU Antibiotic DDD ESBL MRSA |
| url | http://link.springer.com/article/10.1186/s12879-017-2440-7 |
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