Antimicrobial consumption, costs and resistance patterns: a two year prospective study in a Romanian intensive care unit

Abstract

BackgroundDue 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.MethodsBetween 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.ResultsA 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. ConclusionsSome 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.

Epidemiology, antimicrobial resistance, and incremental medical costs of hospital-acquired infections in the Intensive Care Unit: 2-year experience from Serbia

“…Incremental medical costs -microbiological testing and antimicrobial treatment, were obtained and revealed valuable insights into the burden of HAI in Serbia. Although we were not able to estimate an in-depth burden of HAIs by type and possibly by antimicrobial resistance patterns [4,28], several small-scale studies such as ours were done in other countries and achieved to show a substantial burden of HAI [29][30][31][32]. Our intent is to use this data as the starting point to leverage large-scale prospective studies that would effectively show the actual costs of HAIs in our country.…”

Analysis of Antimicrobial Medication Consumption in Intensive Care Unit, North West (Tabuk) Region Hospitals, Saudi Arabia

“…The drug consumed most by adults, pediatrics and neonates was parenteral Ceftriaxone and Vancomycin that's similar previous study with utilization of third general cephalosporin. 12 The specific indication of usage for both antibiotics was not evident in the study and not included in the aim of the study. In neonates, the parenteral Quinolones were highly consumed; however, caused an adverse event to pediatrics less than eighteen years.…”

“…8 Several studies showed differences in types of antibiotics used in each country. [9][10][11][12][13] At best to the author's knowledge, there is no study done at KSA or Gulf and Middle East countries about antibiotics consumption in critical care services. The goal of the study is to explore the antibiotics consumption at critical care units in the Northern region (Tabuk) of the Kingdom of Saudi Arabia.…”

A cross-sectional research conducted in Malatya province, Turkey: Knowledge levels and awareness about rational antibiotic use and antimicrobial resistance before and after graduation

“…In the group 2, there were males 66.5%, females 33.5% between 25-66 years of age, the mean age was 41±9 years. The professional experience of the group 2 was 13.9% had 1-5 years, 19.6% had 6-10 years, and 66.5% had 11 years or more.…”