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

Carmen Axente,Mirela Voicu,Roxana Moldovan,Luminita Baditoiu,Monica Licker,Dorina Dugaesescu,Florin Horhat,Delia Muntean,Ovidiu Bedreag,Dorel Sandesc,Elena Hogea,Marius Papurica

doi:10.1186/s12879-017-2440-7

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.

Highlights

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
The intensive care unit (ICU) is often called the epicentre of infections, due to its extremely vulnerable patients, the wide use of invasive devices and broadspectrum antimicrobials, which favours the emergence of multidrug resistance (MDR) [1,2,3]
Even though carbapenems should not be used for prophylactic purposes, in our study we found 8.16 Defined Daily Dose (DDD) per 1000 patient-days used in SI, despite the fact that the patient file did not contain any mentions on clinical symptoms or microbiologic tests to support a diagnosis of infection

Summary

Introduction

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. 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. The intensive care unit (ICU) is often called the epicentre of infections, due to its extremely vulnerable patients, the wide use of invasive devices and broadspectrum antimicrobials, which favours the emergence of multidrug resistance (MDR) [1,2,3]. The prognosis of patients who develop hospital-acquired infections (HAI) in the ICU is poor and the mortality rates are higher if it involves an MDR organisms [4]. Pseudomonas aeruginosa strains resistant to 3 or more antibiotic classes had their highest level of incidence levels in Romania, Bulgaria and Greece (with percentages being between 25 and 50%) and the incidence of MDR Acinetobacter spp. reached a peak in Italy, Greece and Portugal, with slightly lower percentages (under 50%) in Bulgaria, Romania, and Hungary [8]

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