Surveillance of Antibiotic Prescribing in Intensive Care Units in Poland

Abstract

Antibiotic use and microbial resistance in health care-associated infections are increasing globally and causing health care problems. Intensive Care Units (ICUs) represent the heaviest antibiotic burden within hospitals, and sepsis is the second noncardiac cause of mortality in ICUs. Optimizing appropriate antibiotic treatment in the management of the critically ill in ICUs became a major challenge for intensivists. We performed a surveillance study on the antibiotic consumption in 108 Polish ICUs. We determined which classes of antibiotics were most commonly consumed and whether they affected the length of ICU stay and the size and category of the hospital. A total of 292.389 defined daily doses (DDD) and 192.167 patient-days (pd) were identified. Antibiotic consumption ranged from 620 to 3960 DDD/1000 pd. The main antibiotic classes accounted for 59.6% of the total antibiotic consumption and included carbapenems (17.8%), quinolones (14%), cephalosporins (13.7%), penicillins (11.9%), and macrolides (2.2%), respectively, whereas the other antibiotic classes accounted for the remainder (40.4%) and included antifungals (34%), imidazoles (20%), aminoglycosides (18%), glycopeptides (15%), and polymyxins (6%). The most consumed antibiotic classes in Polish ICUs were carbapenems, quinolones, and cephalosporins, respectively. There was no correlation between antibiotic consumption in DDD/1000 patient-days, mean length of ICU stay, size of the hospital, size of the ICU, or the total amount of patient-days. It is crucial that surveillance systems are in place to guide empiric antibiotic treatment and to estimate the burden of resistance. Appropriate use of antibiotics in the ICU should be an important public health care issue.

Characteristics of Microbial Factors of Healthcare-Associated Infections Including Multidrug-Resistant Pathogens and Antibiotic Consumption at the University Intensive Care Unit in Poland in the Years 2011–2018

“…The fact that an increase in the consumption of carbapenems during the analyzed period may correspond with an increase in alert pathogens cultured from hospital-acquired infections, mainly the ESBL-type resistance mechanism, is also noteworthy. The data from the Polish and European ICUs confirm the results of our study in that carbapenems and fluoroquinolones are most frequently used in this group of patients [ 30 , 33 ].…”

The Incidence of Healthcare-Associated Infections, Their Clinical Forms, and Microbiological Agents in Intensive Care Units in Southern Poland in a Multicentre Study from 2016 to 2019

“…However, analysis of the Polish literature from earlier years presented below demonstrates that the incidence of HAI in Polish ICUs was higher. In a Polish single-centre study by Wieder-Huszla [ 6 ], the incidence was 24% (in 2010). An identical incidence of 24% was obtained by Kübler et al [ 11 ] in 2012.…”

“…Another ECDC report from the ESAC-Net indicates a higher rate of antibiotics consumption in the community sector in Poland than the average European rate. Although the analogous rate for the hospital sector is lower than the European average, some Polish studies dedicated to intensive care units (ICUs) have revealed troubling results of antibiotic consumption in these wards together with very high rates of resistant bacteria isolated from infections [ 6 , 7 ].…”

Consumption of Antibiotics and Epidemiology of Clostridioides difficile in the European Union in 2016—Opportunity for Practical Application of Aggregate ECDC Data

“…However, the above example was not an exception: A multi-center study in Polish ICUs indicated consumption of antibiotics at an average level of 1520 DDD/1000 pds (ranging from 620 to 3960 DDD/1000 pds). These data were significantly higher than analogous rates recorded in, e.g., Germany, 1305 (463-2216), or Sweden, 1147 (605-2134 DDD/1000 pds) [15][16][17]. What is also worrying in Polish ICUs is the high contribution of carbapenems (17%) and quinolones (14%, the second antibiotic class) that was found, while it is precisely the proportion of broad-spectrum antibiotics and fluoroquinolones in the total antibiotic consumption that constitutes a parameter evaluating the quality of prescribing antibiotics [17].…”