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Computerized surveillance of antibiotic usage and resistance: monitoring the impact of interventions

Abstract number: P1501

Lye D., Ng T.M., Teng C.B., Ling L.M., Hsieh I.J., Yeak S.C., Tai H.Y., Leo Y.S., Ang B.S.

Objectives: With high rates of multidrug-resistant (MDR) bacteria, we aimed to monitor antibiotic usage and resistance rapidly, at hospital and unit level, and in response to any intervention.

Methods: We built a computer programme downloading daily data on all positive cultures from Microbiology since January 2006, and antibiotic dispensing from Pharmacy since January 2007. Infection control (IC) and antimicrobial stewardship programme (ASP) interventions included: active MRSA surveillance and decolonisation from October 2006, enhanced with chlorhexidine wipes from November 2008 in medical Intensive Care Unit (ICU); hospital-wide MDR Gram-negative bacteria (GNB) isolation and hand hygiene campaign from January 2009; ertapenem to treat ESBL GNB from late 2007; an empiric antibiotic guideline from March 2009; and prospective review and feedback on all carbapenem orders from April 2009.

Results: Rise in amoxycillin–clavulanate and cefepime from March 2009 coincided with empiric guideline. Rise in ertapenem coincided with fall in imipenem from October 2007. Meropenem use fell from 27DDD/1000 bed-days in May 2008 to 17DDD/1000 bed-days in April 2009 and 10 in August 2009. Ceftriaxone fell from 141DDD/1000 bed-days in January 2007 to 93DDD/1000 bed-days in August 2009. Piperacillin–tazobactam rose from 40DDD/1000 bed-days in February 2008 to 54DDD/1000 bed-days in June 2009. Usage of vancomycin, ceftazidime and fluoroquinolones remained stably high. Incidence of MRSA fell from 3.1/1000 bed-days in January 2006 to 1.9/1000 bed-days in August 2009. MDR Acinetobacter baumannii (MDR AB) fell from 1.4/1000 bed-days in February 2006 to 0.16/1000 bed-days in February 2008, but rose to 1.8/1000 bed-days in August 2009; this rise was most marked in surgical and medical ICUs. ESBL Escherichia coli and Klebsiella, and carbapenem-resistant Pseudomonas aeruginosa remained stable. Active MRSA surveillance in medical ICU failed to reduce MRSA incidence but chlorhexidine wipes did. MDR GNB isolation was limited by lack of isolation rooms. Hand hygiene compliance did not correlate with MRSA or MDR AB incidence.

Conclusions: Computerised surveillance facilitates monitoring of impact of IC and ASP interventions. It highlighted high usage of fluoroquinolones and piperacillin–tazobactam, and a worsening problem of MDR AB. Prospective review and feedback on piperacillin–tazobactam, and a study on MDR AB are planned.

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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