Evaluation of surgical prophylaxis in a tertiary care hospital in Turkey: Point prevalence results

Abstract

Background: Acinetobacter species are important pathogens increasingly reported as causes of nosocomial infections. They are often multi-drug resistant organisms responsible for increased patient morbidity and mortality. The aim of this study was to determine the impact of an Antimicrobial Stewardship Program on preventing the development of Acinetobacter antimicrobial resistance and patient outcomes. Methods & Materials: A retrospective data analysis was performed on patientswith documented Acinetobacter infections from January 1st to December 31st, 2012 to determine themortality rate. Charts were reviewed for risk factors that may have contributed to mortality to prevent confounding factors. Results: Acinetobacter species were isolated in 23 patients in 2012. There were 2 healthcare-associated pneumonias (8.7%), 6 ventilator-associated pneumonias (VAP) (26.1%), 3 healthcareassociated Urinary Tract Infections (13%), 3 bacteremias (13%), 1 appendicitis (2.9%), and 8 skin & soft tissue infections (34.8%). There were 3 deaths during the study period. Themortality rate forAcinetobacterhealthcare – associated and ventilator –associated pneumonias was 12.5% which is considerably less than quoted in the literature (39.2%). The mortality rate for Acinetobacter bacteremiaswas 0%which is considerably less thanwhat the literature quotes (22.1%) despite our patients having many of the risk factors associated with increased mortality. The improved outcomes may have been because most Acinetobacter strains within Palomar Health were sensitive to first-line antimicrobial agents. Both antimicrobial formulary restriction and limiting antimicrobial sensitivity reporting has resulted in more patients being switched to narrow spectrum antimicrobials. Conclusion: As a result of antimicrobial stewardshipwithin our health system, most Acinetobacter species including baumannii are susceptible to first-line antimicrobials. Changing how the microbiologists report sensitivities for Gramnegative bacteria can have a significant impacton theuseof carbapenems. It improved the selection of antimicrobials in the treatment of Acinetobacter infections while helping maintain bacterial susceptibility to carbapenems. Having anAntibiotic Stewardship Programhashelped slow the rate of bacterial resistance within our hospitals and improve outcomes.