Antibiotic use and bacterial resistance in German intensive care units: data from project SARI (Surveillance of Antibiotic Use and Bacterial Resistance in German Intensive Care Units) from 2000 to 2004
Abstract number: 1134_02_257
Meyer E., Schwab F., Jonas D., Rüden H., Gastmeier P., Daschner F.D.
To study data on antibiotic resistance, prophylactic or therapeutic use of antibiotics in ICUs, on changes over time, and on the correlation between antibiotic use and resistance rates in intensive care units (ICUs) in Germany.
Prospective, unit-based surveillance in which ICUs collected data on patient days, antibiotic use (defined daily doses = DDD according WHO) and resistance rates of selected non-duplicate pathogens. Antibiotic use density (AD) is calculated in DDDs/1000 patient days. The data were recorded, analysed centrally and communicated to the participants every six months (www.sari-antibiotika.de).
Starting in 02/2000, by 6/2004) SARI had recorded data provided by 40 ICUs covering a total of 1571 months, 578,760 patient days and 773,306 defined daily doses. On average, each patient received 1.2 doses of an antibiotic per ICU-day. Antibiotic usage rates were highest for penicillins with lactamase inhibitor (AD 297) and chinolones (AD 156).
Resistance data were collected on 53,038 isolates of 13 pathogens: S. aureus (n = 11750; 22.2%), S. pneumoniae (n = 881; 1.7%), coagulase-negative Staphylococci (n = 8373; 15.8), E. faecalis (n = 5463; 10.3%), E. faecium (n = 1888; 3.6%), E. coli (n = 8614, 16.2%), K. pneumoniae (n = 3310, 6.2%), E. cloacae (n = 3033, 5.7%), Citrobacter spp. (n = 970, 1.8%), S. marcescens (n = 1011; 1.9%), P. aeruginosa (n = 5109; 9.6%), A. baumannii (n = 1247; 2.4%) and S. maltophilia (n = 1389; 2.6%).
The resistance situation in Germany is still highly heterogenous: MRSA-rates range from 2.9% to 66.7% (mean 21.2%); according to DIN testing ciprofloxacin resistant E. coli rates range from 0.8% to 50.0% (mean 12.5%) and imipenem resistant P. aeruginosa rates range from 0.0% to 47.8% (mean 25.0%). Over a period of three years (20012003), a significant increase was only seen in ciprofloxacin resistant E. coli by Wilcoxon sing rank test for paired samples. Antibiotic use and bacterial resistance rates are still highly heterogenous in German ICUs. The large differences between ICUs indicate that initiatives may be most effective when undertaken at the local level. Over a period of three years (20012003), a significant increase was only seen in ciprofloxacin resistant E. coli.
|Session name:||XXIst ISTH Congress|
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