Abstract
Antibiotic abuse can lead to antibiotic resistance, which is a severe problem in China. The purpose of this study is to evaluate the short-term effects of antimicrobial stewardship strategies, including formulary restriction, preauthorization, perioperative quinolone restriction, and control of total antibiotic consumption in the ICU at a tertiary hospital in China. After implementation of antimicrobial stewardship, the total antibiotic consumption in the ICU significantly decreased. The defined daily doses (DDDs) per 100 patient-days decreased from 197.65 to 143.41; however, the consumption of cephalosporins increased from 53.65 to 63.17 DDDs. Significant improvements in resistance to amikacin, gentamicin, ciprofloxacin, ofloxacin, ceftriaxone, ceftazidime, and piperacillin in Enterobacteriaceae and resistance to ceftazidime, imipenem, and meropenem in non-fermenting Gram-negative rods were observed. In addition, the initial use of no antibiotics or of a single antibiotic significantly increased (P<0.001) and the use of two antibiotics in combination significantly decreased (P<0.001). Our results demonstrate that implementation of antimicrobial stewardship in a short period in the ICU dramatically reduced antibiotic consumption and significantly improved antibiotic resistance, which leads to more reasonable antibiotic selections by ICU physicians.
Highlights
Since antibiotics were first applied in clinical settings, more varieties have emerged, resulting in the recovery of numerous critically infected patients [1]
Such antibiotic overuse and the rapid growth rate of antibiotic resistance are serious in intensive care units (ICUs) because patients in ICUs usually have serious health problems
We found a higher proportion of no antibiotic therapy or single antibiotic therapy in the ‘after’ period, which may be explained by the hospital-wide implementation of antimicrobial stewardship strategies (Table 1)
Summary
Since antibiotics were first applied in clinical settings, more varieties have emerged, resulting in the recovery of numerous critically infected patients [1]. Comparison of the patterns of antibiotic resistance among bacteria of clinical relevance in China, Kuwait and the USA demonstrated that China had the highest level of antibiotic resistance and the most rapid growth rate of resistance among the three countries [4]. Such antibiotic overuse and the rapid growth rate of antibiotic resistance are serious in intensive care units (ICUs) because patients in ICUs usually have serious health problems. An investigation demonstrated that in China’s ICUs, the antibiotic resistance rate of common pathogens is increasing every year [5]
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