Microbiologic Surveillance and Parenteral Antibiotic Use in a Critical Care Unit

Abstract

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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