Surveillance of microbial resistance in European Intensive Care Units: a first report from the Care-ICU programme for improved infection control
- 514 Downloads
To report initial results from a European ICU surveillance programme focussing on antibiotic consumption, microbial resistance and infection control.
Thirty-five ICUs participated during 2005. Microbial resistance, antibiotic consumption and infection control stewardship measures were entered locally into a web-application. Results were validated locally, aggregated by project leaders and fed back to support local audit and benchmarking.
Median (range) antibiotic consumption was 1,254 (range 348–4,992) DDD per 1,000 occupied bed days. The proportion of MRSA was median 11.6% (range 0–100), for ESBL phenotype of E. coli and K. pneumoniae 3.9% (0–80) and 14.3% (0–77.8) respectively, and for carbapenem-resistant P. aeruginosa 22.5% (0–100). Screening on admission for alert pathogens was commonly omitted, and there was a lack of single rooms for isolation.
The surveillance programme demonstrated wide variation in antibiotic consumption, microbial resistance and infection control measures. The programme may, by providing rapid access to aggregated results, promote local and regional audit and benchmarking of antibiotic use and infection control practices.
KeywordsIntensive care Antibiotic consumption Microbial resistance Infection control
We wish to express our gratitude to all contributors in the CareICU network (see below), Fredrik Husander for web design and Mercedes Palomar and Dominique Monnet for valuable help with design of the questionnaire. The network was funded by the European Commission Directorate General for Health and Consumer Protection (DG SANCO) through the project Improving Patient Safety in Europe (IPSE, http://ipse.univ-lyon1.fr). Funding was also received from the Swedish Institute for Infectious Disease Control (www.smittskyddsinstitutet.se). Contributors: Ante Sekulic, Kresimir Oremus, Ljiljana Betica Radic, Marina Payerl Pal, Radovan Radonic, and Smilja Kalenic in Croatia; Václav Vaniš and Vlastimil Jindrak in the Czech Republic; Paul Naaber and Piret Mitt in Estonia; Anikó Farkas, Karolina Böröcz, Andrea Kurcz, Piroska Orosi, Erzsébet Rákay and Erika Rauth in Hungary; Elizabeth Scicluna in Malta; Monica Licker in Romania; Anita Johansson, Anne-Li Öhlin Gustafsson, Hans Blomqvist, Jonas Swanberg and Margareta Lannér Sjöberg in Sweden and Cengiz Uzun, Dilek Arman, Davut Ozdemir and Murat Dizbay in Turkey.
- 7.Hanberger H, Burman LG, Cars O, Erlandsson M, Gill H, Nilsson LE, Nordlinder D, Walther SM, ICU STRAMA Study Group (2007) Low antibiotic resistance rates in Staphylococcus aureus, Escherichia coli and Klebsiella spp but not in Enterobacter spp and Pseudomonas aeruginosa: a prospective observational study in 14 Swedish ICUs over a 5-year period. Acta Anaesthesiol Scand 51:937–941PubMedCrossRefGoogle Scholar
- 8.Tato M, Coque TM, Ruíz-Garbajosa P, Pintado V, Cobo J, Sader HS, Jones RN, Baquero F, Cantón R (2007) Complex clonal and plasmid epidemiology in the first outbreak of Enterobacteriaceae infection involving VIM-1 metallo-beta-lactamase in Spain: toward endemicity? Clin Infect Dis 45:1171–1178PubMedCrossRefGoogle Scholar
- 10.Brun-Buisson C (2008) ICU-acquired infections and sepsis: more of a deadly duo. Intensive Care Med 34:793–795Google Scholar
- 12.Hanberger H, Arman D, Gill H, Kalenic S, Naaber P, Scicluna E, Suetens C (2008) CARE-ICU—Controlling Antibiotic REsistance in Intensive Care Units—First report from a web-based program for improved infection control in European ICUs. In: Programme of the 18th European congress of clinical microbiology and infectious diseases, BarcelonaGoogle Scholar
- 13.Hanberger H, Erlandsson M, Burman LG, Cars O, Gill H, Lindgren S, Nilsson LE, Olsson-Liljequist B, Walther S, the ICU-STRAMA Study Group (2004) High antibiotic susceptibility among bacterial pathogens in Swedish ICUs. Report from a nation-wide surveillance program using TA90 as a novel index of susceptibility. Scand J Infect Dis 36:24–30PubMedCrossRefGoogle Scholar
- 16.de With K, Bergner J, Buhner R, de With K, Bergner J, Bühner R, Dörje F, Gonnermann C, Haber M, Hartmann M, Rothe U, Strehl E, Steib-Bauert M, Kern WV et al (2004) Antibiotic use in German university hospitals 1998–2000 (Project INTERUNI-II). Int J Antimicrob Agents 24:213–221PubMedCrossRefGoogle Scholar
- 18.Meyer E, Schwab F, Gastmeier P, Rueden H, Daschner FD, Jonas D (2006) Stenotrophomonas maltophilia and antibiotic use in German intensive care units: data from Project SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in German Intensive Care Units). J Hosp Infect 64:238–243PubMedCrossRefGoogle Scholar
- 21.Monnet DL SC, Jepsen OB (2000) Overall antimicrobial use and control strategies in intensive care units from 6 European countries. Abstract; 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections. CDC/SHEA, AtlantaGoogle Scholar
- 24.Lucet J-C, Paoletti X, Lolom I, Paugam-Burtz C, Trouillet J-L, Timsit J-F, Deblangy C, Andremont A, Regnier B (2005) Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med 31:1051–1057Google Scholar
- 27.Harbarth S, Fankhauser C, Schrenzel J, Christenson J, Gervaz P, Bandiera-Clerc C, Renzi G, Vernaz N, Sax H, Pittet D (2008) Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 299:1149–1157PubMedCrossRefGoogle Scholar
- 28.Cepeda JA, Whitehouse T, Cooper B, Hails J, Jones K, Kwaku F, Taylor L, Hayman S, Cookson B, Shaw S, Kibbler C, Singer M, Bellingan G, Wilson AP (2005) Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study. Lancet 365:295–304PubMedGoogle Scholar
- 34.Peña C, Guzmán A, Suarez C, Dominguez MA, Tubau F, Pujol M, Gudiol F, Ariza J (2007) Effects of carbapenem exposure on the risk for digestive tract carriage of intensive care unit-endemic carbapenem-resistant Pseudomonas aeruginosa strains in critically ill patients. Antimicrob Agents Chemother 51:1967–1971PubMedCrossRefGoogle Scholar
- 35.Erlandsson M, Gill H, Nilsson LE, Giske, Jonas, Nordlinder D, Walther SM, Hanberger H (2008) Antibiotic susceptibility patterns and clones of Pseudomonas aeruginosa from patients in Swedish ICUs. Scand J Infect Dis 40:487–494Google Scholar