Abstract
The purpose of the study is to assess the possibility of managing the antibiotic resistance level and consumption of antimicrobial agents in a hospital based on the analysis of the drug resistance index. Material and methods. The antibiotic consumption planning system was employed at the multidisciplinary surgical hospital based on the unified Registry of microorganisms (ROM). ROM included data on 25.581 strains obtained from patients with infections admitted to the intensive care units (ICU) and specialized departments. Protocols of empiric antimicrobial therapy and perioperative antibiotic prevention were developed. The ROMbased system allowed automated calculation of drug resistance indices for nosocomial microor ganisms. Data obtained during the preintervention period (2012) and intervention period, (2014—2015) were compared. Results. Decreases in the drug resistance indices for Pseudomonas aeruginosa from 0.721 in 2012 to 0.596 in 2015, Acinetobacter baumannii from 0.96 in 2012 to 0.889 in 2015, Klebsiella pneumoniae from 0.728 in 2012 to 0.595 in 2015 were achieved due to reduction of antimicrobial resistance, reduced consumption of III—IV generation cephalosporins and antipseudomonal carbapenems, and more frequent use of ertapenem for treatment of infections caused by Klebsiella pneumoniae. There was an increase in the drug resistance index of Escherichia coli from 0.325 in 2012 to 0.382 in 2015 due to increased consumption of protected penicillins and first generation cephalosporins for prevention in abdominal surgery and urology and increased pathogen resistance to these antibiotics. Conclusion. A development of a unified hospital ROM and application of the drug resistance index for math ematical modeling of the pathogens resistance level allows to perform timely monitoring of changes in antibiotic resistance of nosocomial microorganisms in ICU setting and other hospital departments and proper managinge the antibiotics prescription.
Highlights
Прогресс информационных, телекоммуни кационных и медицинских технологий оказал существенное влияние на развитие современ ных направлений организации оказания меди цинской помощи [1]
Special attention was paid to ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) Gram negative pathogens in the study of the antibi otic resistance degree and calculating the drug resistance index (DRI) [18], since infections caused by these microorganisms pre sent the greatest difficulties in choosing empiric and targeted AMT: Klebsiella pneumoniae CP+ — K. pneumoniae producing carbapenemases; Рис. 1
Introduction of ATCS had the greatest effect on the DRI reduction for K. pneumoniae, the index dropped from 0.728 in 2012 to 0.595 in 2015 (Fig. 2 c)
Summary
Телекоммуни кационных и медицинских технологий оказал существенное влияние на развитие современ ных направлений организации оказания меди цинской помощи [1]. В условиях увеличения частоты инфекционных осложнений [5, 6] и по всеместного роста антибиотикорезистентности эмпирическое назначение антимикробных пре паратов (АМП) становится все более сложной задачей для практикующих врачей, поэтому ос новной целью создания Протоколов было фор мирование единого алгоритма принятия реше ния о назначении адекватной стартовой АМТ, так как от эффективности последней зависит исход лечения больных инфекцией [7,8,9,10,11,12,13,14]. The achieved changes were rather due to the decrease in antibiotic resistance than the reduced consumption of AMA potentially effective against this bacterium. There was a significant decrease in resistance of K. pneumoniae to all AMA groups except aminopenicillins.
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