Effect of the antimicrobial stewardship protocol on the results of treatment of ICU patients with respiratory infections in a multidisciplinary hospital. Article

Abstract

The purpose of the study was to evaluate the effectiveness of implementation in real practice of multidisciplinary hospital ICU a local Protocol for the treatment of respiratory infections. Materials and methods. The retrospective interventional study with historical control was performed in a regional clinical hospital with 940 beds. The Protocol was based on the results of local bacteriological data and included indications for start therapy, algorithm for selecting and canceling the antibiotic treatment. We included in analysis data from all patients with pneumonia and purulent tracheobronchitis who were treated in ICU for previous andnext year after the implementation of the Protocol (pre- and intervention period). In accordance with the diagnostic criteria, a group of 146 patients was formed out of 1090 patients who were treated in ICU in preintervention period and to compare with 174 patients group in the interventional period out of 1465 ICU patients. Results. The implementation of the Protocol helped to reduce the average duration of the AMT course from 13.7 to 10.4 days, p < 0.01, the frequency of recurrence of pulmonary infection (22.6 % and 12.6 %, p = 0.028), the duration of artificial ventilation (p < 0.01) and treatment in ICU (for 3 days, p = 0.025). Overall mortality in the groups decreased insignificantly (p = 0.06). Conclusion. Protocol for respiratory infections treatment is an effective tool for control of antimicrobial therapy. The implementation of the Protocol helps physician to timely and reasonably prescribe those antibiotics to the patient that will ensure an early start of effective therapy, and then also reasonably change the scheme or stop therapy. As a result, treatment results are improved, the probability of progression or recurrence of infection is reduced, the need of ventilatory support is reduced, as well as the duration of respiratory support and stay of patients in the ICU.