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An integrated approach to control ICU-associated infections focusing on antimicrobial consumption and resistance rates

Abstract number: R2267

Objectives: The emergence and spread of antimicrobial resistance has become a major public health threat and antimicrobial usage is a key factor for resistance because it allows selection or emergence of resistant pathogens. The main objective of our study was to provide Intensive Care Unit-specific and national benchmark data both on antimicrobial consumption and on resistance rates (RR).

Methods: Intensive Care Units (ICUs) already participating in the first edition of the Italian Nosocomial Infections Surveillance in Intensive Care Units (Sorveglianza Prospettica delle Infezioni Nosocomiali nelle Unità di Terapia Intensiva – SPIN-UTI), established by the Italian Study Group of Hospital Hygiene (GISIO) of the Italian Society of Hygiene (SItI) were invited to take part in the study. The project used an integrated approach: a unit-based approach for the surveillance of antimicrobial use and a patient-based approach for the surveillance of antimicrobial resistance in Italian ICUs.

Results: The study was conducted between November 2006 and April 2007, and included 21 ICUs, 1685 patients with length of stay longer than two days and 18,694 patient-days, producing a total of 79,423 defined daily doses (DDDs). During the study period, the antimicrobial usage density (AD = DDD/1000 patient days) was 4,248.47 DDD units per 1000 patient-days. The three most used drug groups were penicillins/b-lactamase inhibitors (AD 13,921), quinolones (AD 12,806) and glycopeptides (AD 7,453). The single most frequently prescribed antimicrobial agent was ampicillin/sulbactam (DDDs 12,220; AD 653.7), followed by levofloxacin (DDDs 9,940; AD 531.7) and fluconazole (DDDs 8,836; AD 472.7). Susceptibility data were reported on 353 isolates. The most frequent infection-associated pathogen was "Pseudomonas aeruginosa" followed by "Acinetobacter baumannii" and "Staphylococcus aureus"; "Candida" spp accounted for 4.3%. RR were 95.3% and 48.0% for ceftazidim-resistant "A. baumannii" and "P. aeruginosa" respectively; 83.3% and 35.2% for imipenem-resistant "A. baumannii" and "P. aeruginosa" respectively, and 47.6% for oxacillin-resistant "S. aureus".

Conclusion: Comparison of resistance patterns and prescribing practices in different ICUs underlines the need for locally adapted guidelines on empiric antimicrobial therapy, based on the evidence of the link between antimicrobial resistance and consumption and on international benchmarking, in order to address effective control measures.

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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