Use of a Microbiology Database to Analyse Changes in Resistance Patterns in the ICU

Abstract

We combined our ICNARC dataset with a microbiology database in a mixed general and neurosurgical intensive care unit (ICU). We identified 1,097 positive tracheal aspirate cultures in 2,525 consecutive adult patients admitted over a three-year period. The database enabled us to track changes in tracheal aspirate flora and antibiotic resistance patterns following the introduction of a hospital-wide restrictive antibiotic policy targeted at Clostridium difficile infection (CDI) reduction. The pattern of organism types was unchanged although meticillin resistance in Staphylococcus aureus decreased from 33% to 17% (p=0.014). Sensitivity of tracheal aspirate cultures to empirical antibiotics increased from 67% to 86% in the first five days after hospital admission and from 53% to 81% in the subsequent five days. A combined microbiology/ICU database allowed resistance patterns to be identified within our unit. We believe this should be developed nationally both for research and for real time targeting of empiric antibiotic therapy.