Antimicrobial stewardship and bacterial resistance in the intensive care unit

Abstract

Objective To investigate the changes of antibiotic resistance and its correlations with antibiotics use density (AUD) in intensive care unit (ICU) after implementation of antimicrobial stewardship. Methods Data on AUDs and synchronous antibiotic resistance in ICU of the Affiliated Hospital of Taishan Medical University during 2010 and 2014 were retrospectively reviewed. Autoregressive integrated moving average (ARIMA) model was used to identify the correlation between AUDs and antibiotic resistance. Results The total AUD which stood at 163.46 DDDs·100 person-1·d-1 in the year 2010 decreased to 68.20 DDDs·100 person-1·d-1 in 2014, and the most significant decreases were found in quinolones, imidazole, carbapenems, aminoglycosides, other beta lactam and macrolides. Synchronously, a wide range of improvements in antibiotic resistance of major pathogens were also observed from 2010 to 2014, and the improvements were positively correlated with the decrease of AUDs. However, antibiotic resistance in 2014 was not significantly improved compared with that in 2013. The rate of ciprofloxacin resistance in Pseudomonas aeruginosa and the resistant rates of amikacin, imipenem, and meropenem in Acinetobacter baumannii even increased in 2014. Conclusions With the implementation of antimicrobial stewardship, antibiotic consumption in ICU was decreasing, and antibiotic resistance rate in major pathogenic bacteria was decreasing. But the rebound in antibiotic resistance in some types of bacteria was also observed and should be put on enough caution. Key words: Anti-bacterial agents; Intensive care units; Drug resistance, bacterial; Antimicrobial stewardship