Antibiotic consumption after implementation of a procalcitonin-guided antimicrobial stewardship programme in surgical patients admitted to an intensive care unit: a retrospective before-and-after analysis
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To analyse antibiotic use density (AD)—World Health Organization defined daily doses/1,000 patient-days—before and after implementation of a local antimicrobial stewardship programme (ASP) in conjunction with a procalcitonin (PCT)-guided protocol in a surgical intensive care unit (ICU).
In this retrospective observational study, data on 2,422 ICU patients between 2010 and 2012 were analysed. In 2011, an ASP in conjunction with a PCT protocol had been introduced into clinical practice. In a multivariate analysis, hospital mortality, length of stay (LOS) in hospital and ICU LOS were adjusted for effects from effective cost weight, gender, and age. AD and changes in the use of antibiotic classes were analysed.
AD decreased from 1,005.0 in 2010 to 791.9 in 2012 which is a total reduction of 21.2 %. Consumption of aminoglycosides, cephalosporins and quinolones showed a marked reduction, whereas the use of penicillins did not change significantly. The multivariate models revealed no relevant changes in mortality rate, ICU LOS and hospital LOS.
Implementation of an ASP in conjunction with a PCT protocol in 2011 was associated with a marked decrease in total AD and led to a significant change in the spectrum of antibiotics. Clinical outcomes appeared to remain unchanged over the study period.
KeywordsAntibiotic usage Intensive care unit (ICU) Surveillance Antimicrobial stewardship Procalcitonin
S. Hertel as an employee of Thermo Fisher Scientific performed the statistical analysis. Data were generated as part of the routine work and no other kind of funding has been received. S. Schroeder served as consultant and has received payments from BRAHMS AG for speaking engagements. A. Hohn, S. Schroeder and B. Heising carried out data collection, contributed to the design of the study and drafted the manuscript. S. Hertel participated in the design of the study, performed the statistical analysis and drafted the manuscript. G. Baumgarten and M. Hochreiter participated in the design of the study and drafted the manuscript. All authors read and approved the final manuscript.
Conflict of interest
All other authors declare no conflict of interest.
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