Focused microbiological surveillance by specific hospital unit as a sensitive means of defining antimicrobial resistance problems

Stratton, Charles W.; Ratner, Hilda; Johnston, Philip E.; Schaffner, William

doi:10.1016/0732-8893(92)90003-c

Cited by 38 publications

(23 citation statements)

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“…It has been suggested that surveillance of bacterial resistance patterns is a useful technique to control the emergence of resistant organisms (5). Early detection of resistant organisms allows for specific measures to be implemented to prevent the widespread transmission of bacterial resistance.…”

Section: Surveillance Microbiologique Et Antibiothérapie Par Voie Parmentioning

confidence: 99%

Microbiologic Surveillance and Parenteral Antibiotic Use in a Critical Care Unit

Yamashita

Louie

Simor

et al. 2000

Canadian Journal of Infectious Diseases and Medical Microbiolog

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OBJECTIVE:To evaluate parenteral antibiotic utilization and bacterial resistance patterns in a critical care unit (CrCU). DESIGN: Descriptive, prospective audit of infection site, culture and antimicrobial susceptibility test results, parenteral antibiotic usage and duration, total antibiotic acquisition costs, and length of stay. SETTING: A 17-bed medical-surgical CrCU in a tertiary care teaching hospital in Metropolitan Toronto. PATIENTS: Two hundred and fifty-eight patients admitted to the CrCU between May 1995 and April 1996 who received antimicrobial therapy. RESULTS:The most frequently prescribed antibiotics were cefazolin (47%, 1098 g), gentamicin (33%,141 g) and ceftriaxone (20%, 255 g). The most common indications for antimicrobial therapy included surgical prophylaxis (34%) and pneumonia (35%). The following organisms were isolated from patients treated with antibiotics: Staphylococcus aureus (26%), Pseudomonas aeruginosa (13%), enterococci (12%), Haemophilus influenzae (11%), Escherichia coli (11%), Enterobacter cloacae (8%) and other . Only 9% of Gram-negative bacilli were resistant to aminoglycosides, 3% were resistant to ciprofloxacin and no extended-spectrum beta-lactamases or imipenem-resistance were detected. No vancomycin-resistant enterococci and only two methicillin-resistant Staphylococcus aureus isolates were identified. CONCLUSIONS: Antibiotic use during the audit appeared appropriate for the specific clinical indications. Low levels of bacterial resistance were detected during the audit. voir page suivante T he emergence of antimicrobial resistance over the past several decades has challenged the management of infections in hospitalized patients, and has led to increased morbidity, higher health care costs and prolonged hospitalizations (1). Hospitals are now frequently encountering outbreaks of resistant organisms such as vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). Patients admitted to intensive care units, in particular, often become colonized with resistant organisms and may serve as the focus for hospital-wide bacterial resistance (2). The high prevalence of resistance in intensive care units (ICUs) has been attributed to the severity of illness of the patients, prolonged hospital stays, and the widespread use of invasive devices and broad spectrum antibiotics (3,4).It has been suggested that surveillance of bacterial resistance patterns is a useful technique to control the emergence of resistant organisms (5). Early detection of resistant organisms allows for specific measures to be implemented to prevent the widespread transmission of bacterial resistance. Furthermore, as the choice of antimicrobial therapy for nosocomial infections is often governed by local resistance patterns, surveillance of bacterial susceptibility can aid in making decisions regarding empirical antimicrobial therapy at each institution. The collection of information on antibiotic usage is also essential because selective pressure exerted by the use of certain ...

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Section: Surveillance Microbiologique Et Antibiothérapie Par Voie Parmentioning

confidence: 99%

Microbiologic Surveillance and Parenteral Antibiotic Use in a Critical Care Unit

Yamashita

Louie

Simor

et al. 2000

Canadian Journal of Infectious Diseases and Medical Microbiolog

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“…2,[12][13][14] While national databases contain limited information on this problem, the importance of local trends cannot be overstated. [15][16][17][18][19] Antibiotic prescribing habits differ markedly not only in different regions of the world but also within local communities. For example, the widespread use of ciprofloxacin to treat leg ulcer infections in local dermatologic practice may be at the root of the precipitous increase in ciprofloxacin resistance encountered in our inpatient surveillance.…”

Section: Commentmentioning

confidence: 99%

Analysis of Antibiotic Susceptibilities of Skin Wound Flora in Hospitalized Dermatology Patients

Colsky¹,

Kirsner²,

Kerdel³

1998

Arch Dermatol

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“…This is actually quite predictable as numerous studies have documented higher levels of antibiotic use with resultant higher rates of resistance in the ICU environment. [20][21][22][23][24][25] In a report from Project ICARE, Fridkin and colleagues illustrated higher resistance rates in ICU compared to non-ICU settings, which, in turn, exhibited higher rates than in isolates from outpatients. 26 Moreover, important differences may exist in different ICUs in the same hospital as noted here and by others.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Hospitalwide and Custom Antibiograms for Clinical Isolates of Pseudomonas aeruginosa

2013

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Background: Hospital antibiograms, which are commonly used to determine empiric antibiotic therapy and as a tool in stewardship in a given institution, are open to bias when combining susceptibility results from various sources, hospital locations, and patient groups. Methods: We assessed such differences, using Pseudomonas aeruginosa as a test case, with susceptibility data from 2008 through 2010 in our institution. Each year's data were analyzed separately. A variety of specific or subcategorical antibiograms were compared with each other as well as with versions including all tested isolates and those with results from inpatients and outpatients only. Statistical significance was determined at the .01 level using either chi-square or Fisher exact test, and clinical significance was defined as $10 percentage points. Results: A variety of clinically significant differences were found that illustrated important differences within the intensive care unit environment and based on population, specifically adult versus pediatric. Concordance between statistically significant and clinically significant differences was poor. Conclusion These results corroborate and extend previous similar observations and point to the potential importance of subanalyses in preparing the annual hospital antibiogram.

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Focused microbiological surveillance by specific hospital unit as a sensitive means of defining antimicrobial resistance problems

Cited by 38 publications

References 0 publications

Microbiologic Surveillance and Parenteral Antibiotic Use in a Critical Care Unit

Microbiologic Surveillance and Parenteral Antibiotic Use in a Critical Care Unit

Analysis of Antibiotic Susceptibilities of Skin Wound Flora in Hospitalized Dermatology Patients

Comparison of Hospitalwide and Custom Antibiograms for Clinical Isolates of Pseudomonas aeruginosa

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