CARE-ICU Controlling Antibiotic REsistance in Intensive Care Units First report from a web-based programme for improved infection control in European ICUs
Abstract number: P673
Hanberger H., Arman D., Gill H., Kalenic S., Naaber P., Scicluna E., Suetens C.
Background: CARE-ICU is a web-based programme for IC surveillance in the ICU setting developed within the EU Commission sponsored project IPSE. The aim of the programme is to improve surveillance and control of antibiotic resistance (ABR), AB consumption (ABC) and hygienic precautions in the ICU setting of EU member states.
Methods: A programme for yearly registration of ABC, resistance and clinical practices with automatic feedback through a website http://www4.smittskyddsinstitutet.se/careicu was developed. Participants are national ICU networks and individual ICUs. The national contact points of IPSE were asked to identify ICUs who would be willing to take part in the large pilot study. ABR was defined as the sum of intermediate susceptible and resistant strains. Antibiotics (AB) to which >90% of isolates of a species were susceptible were defined as treatment alternatives (TA90) which is a novel index of susceptibility to measure the magnitude of MDR among Gram-negative bacteria. For each ICU the clinical practices and infection control measures were analysed in relation to the needs based on local resistance patterns and ABC.
Results: 34 ICUs in 8 countries participated in the collection of ICU data for 2005. ABC varied widely from 3484992 DDD1000 (defined daily dosages per 1000 occupied bed days), median 1417 DDD1000. Frequencies of ABR varied greatly between species, ICUs and countries: The median (range) of MRSA, ESBL phenotype of E. coli, ESBL phenotype of K. pneumoniae were in percentages: 11.6 (0100), 3.9 (080) and 14.3 (077.8) respectively. TA90 for P. aeruginosa to aminoglycoside, ceftazidime, ciprofloxacin and carbapenem varied between 0 (9 ICUs), 1 (8 ICUs), 2 (3 ICUs), 3 (6 ICUs) and 4 (4 ICUs). Failure to screen for alert microorganisms in relevant patients at admission was a general problem as well as lack of rooms for isolation precautions and cohort care for patients colonised or infected with Alert organism. Understaffing was common but facilities for hand disinfection was in general available by each bed.
Conclusions: CARE-ICU has become a focal point for promoting more appropriate use of AB and improved infection control. By correlating ABC and resistance, as well as hygienic precautions, best practice in AB policy and hygiene interventions was defined for each unit. The single most needed improvement in almost all settings was increased hygiene compliance of healthcare workers.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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