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Implementing antimicrobial stewardship and control of antibiotic prescription to decrease MRSA in the intensive care unit

Abstract number: P1493

Pagani L., Aschbacher R., Vernaz N., Falciani M., Mian P., Moser B., Zanon P.

Objectives: to evaluate the impact of an Antimicrobial Management Team (AMT) on appropriateness of antimicrobial prescription and control of MRSA prevalence in the Intensive Care Unit (ICU) of a tertiary hospital.

Methods: after reviewing clinical, microbiological and pharmaceutical data of 2002 as historical comparison, a two-phase intervention by the AMT was implemented in our 18-bed general ICU. From January 2003 to March 2004, a regular on-site educational activity was carried out by infectious disease consultant, aimed at defining optimized antimicrobial therapy according to local epidemiology of MRSA and clinical pharmacology parameters. From April 2004 to December 2007, direct control or restriction on antimicrobial prescription by the AMT was added to, and mainly concerned broad-spectrum and last-generation drugs.

Results: the percentage of MRSA isolates recovered in ICU decreased progressively and significantly from 38% (95% CI, 29–47%) in 2002 to 15.6% (95% CI, 6–20%) in 2007 (-5.1% per year; r = -0.99; P = 0.001), which corresponds to a likewise significant decrease in resistance rates: 9.3 MRSA isolates per 1,000 patient-days in 2002 to 3.3 MRSA isolates per 1,000 patient-days in 2007 (-1.3 MRSA isolates per 1,000 patient-days; r = - 0.97; P = 0.001). Variations in consumption of some antimicrobials, expressed in defined daily doses (DDD) per 100 patient-days, were assessed through time-series analysis and are shown in the table.

Conclusion: the interventional antibiotic policy carried out by the AMT has significantly decreased the prevalence of MRSA in this setting. These findings demonstrate that antimicrobial stewardship may help improve patient safety, while decreasing both antimicrobial resistance and aggregate economical costs.

AntimicrobialsJanuary 2002 to December 2002January 2003 to December 2007Trend
 Average monthly use (min-max)% of J01 useAverage monthly use (min-max) % of J01 use 
Total antibiotic use618 (398–810)100%513 (110–829)100%stable
OxacillinNA0%58 (0–200)11%stable
Ampicillin/sulbactam327 (224–525)53%157 (50–368)31%downward*
Cefuroxime10 (0–30)2%6 (0–37)1%downward*
III gen. Cephalosporins80 (25–130)13%46 (0–140)9%downward*
Fluoroquinolones126 (56–182)20%126 (8–274)25%stable
Vancomycin35 (8–75)6%19 (0–73)4%downward*
LinezolidNA0%22 (0–65)4%upward*
*Statistically significant at p-value <5%.

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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