Rational use of antibiotics in the intensive care unit: impact on microbial resistance and costs
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Objective. To evaluate the impact of an intensive care unit (ICU) antibiotic-use policy on the microbial resistance in nosocomial infections and costs.
Design. Comparative study before and after policy implementation.
Settings. An eleven-bed ICU in a general hospital.
Patients. All patients admitted for at least 48 h during a 5year period (1994–1998).
Interventions. In 1995, implementation of an antibiotic-use policy.
Measurements and main results. Patients' general characteristics, incidence of nosocomial infections, antibiotic-selective pressure (the number of days of antibiotic treatment for 1,000 days of presence in the ICU), presence and types of multi-resistant micro-organisms and costs linked to antibiotic use were recorded before (1994) and after implementation of the policy (1995–1998). For each year, patients' general characteristics and the incidence of nosocomial infections were the same. Costs linked to antibiotics use showed a progressive reduction (100% for 1994, 81% for 1995, 65% for 1998). Antibiotic-selective pressure diminished (from 940 days of antibiotic use per 1,000 days (1994) to 610 (1998), p<10–5). A statistically significant reduction in nosocomial infections due to antimicrobial resistant micro-organisms was observed (from 37% (1994) to 15% (1998) of nosocomial infections, p<10–5) after 3 years of implementation of the policy, essentially due to a reduction in methicillin-resistant Staphylococcus aureus and ceftriaxone-resistant Enterobacteriaceae. Nosocomial infections due to ceftazidime-resistant Pseudomonas species or extended-spectrum ß-lactamase Enterobacteriaceae showed no reduction.
Conclusions. Antibiotic-use policy allowed a reduction in antibiotic-selective pressure, costs linked to antibiotics and selective reduction of nosocomial infections due to antimicrobial resistant micro-organisms.
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