Abstract
To evaluate parenteral antibiotic utilization and bacterial resistance patterns in a critical care unit (CrCU). Descriptive, prospective audit of infection site, culture and antimicrobial susceptibility test results, parenteral antibiotic usage and duration, total antibiotic acquisition costs, and length of stay. A 17-bed medical-surgical CrCU in a tertiary care teaching hospital in Metropolitan Toronto. Two hundred and fifty-eight patients admitted to the CrCU between May 1995 and April 1996 who received antimicrobial therapy. The most frequently prescribed antibiotics were cefazolin (47%, 1098 g), gentamicin (33%,141 g) and ceftriaxone (20%, 255 g). The most common indications for antimicrobial therapy included surgical prophylaxis (34%) and pneumonia (35%). The following organisms were isolated from patients treated with antibiotics: Staphylococcus aureus (26%), Pseudomonas aeruginosa (13%), enterococci (12%), Haemophilus influenzae (11%), Escherichia coli (11%), Enterobacter cloacae (8%) and other Gram-negative bacilli (19%). Only 9% of Gram-negative bacilli were resistant to aminoglycosides, 3% were resistant to ciprofloxacin and no extended-spectrum beta-lactamases or imipenem-resistance were detected. No vancomycin-resistant enterococci and only two methicillin-resistant Staphylococcus aureus isolates were identified. Antibiotic use during the audit appeared appropriate for the specific clinical indications. Low levels of bacterial resistance were detected during the audit.
Highlights
OBJECTIVETo evaluate parenteral antibiotic utilization and bacterial resistance patterns in a critical care unit (CrCU)
One-third of patients were admitted from the emergency department, 32% of patients came from the operating room and 35% were transferred to the critical care unit (CrCU) from another ward or hospital
It is difficult to make direct comparisons with other intensive care units (ICUs) without detailed demographic information, the results of our study demonstrated a lower incidence of antimicrobial resistance among bacterial isolates of patients receiving parenteral antibiotics relative to reports from other American and Canadian sites [2,11,12,13]
Summary
To evaluate parenteral antibiotic utilization and bacterial resistance patterns in a critical care unit (CrCU). DESIGN: Descriptive, prospective audit of infection site, culture and antimicrobial susceptibility test results, parenteral antibiotic usage and duration, total antibiotic acquisition costs, and length of stay. The increased use of third-generation cephalosporins in the ICUs, for example, may lead to the selection of highly resistant Gram-negative bacilli [7,8] Surveillance for both bacterial resistance and antimicrobial usage can be used to improve antibiotic prescribing, as well as to detect early changes in resistance patterns that would require intervention. Data were prospectively collected over a one-year period, May 1, 1995 to April 30, 1996, from all patients admitted to the CrCU for more than one day and who received parenteral antimicrobial therapy. A Student’s t-test was used to compare the length of stay of patients who received antibiotics with all patients admitted to the CrCU during the period of audit
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