Abstract
To assess the impact of a restrictive antimicrobial policy, the efficacy of therapeutic and prophylatic antibiotic regimens and the susceptibility patterns of infecting bacterial microorganisms were studied during a two-month period in 1986 in inpatients in a general hospital. Twenty-eight percent of patients received antimicrobial agents, 21 % as treatment and 7 % as prophylaxis. In the 359 evaluable episodes of infection cure was obtained in 88 % of cases with the initial therapy and in 7 % after a change of drugs, but treatment failed in 5 %. Of the 18 cases of failure, improvement was seen in eight although the infection persisted. Ten patients died but in seven of them the infection only partially contributed to this outcome. Ten (8 %) of 127 patients receiving antimicrobial prophylaxis developed an infection but in three there was no relation to the condition for which the prophylactic regimen was originally prescribed. No changes were found in the susceptibility patterns of microorganisms.
Similar content being viewed by others
References
Marr JJ, Moffet HL, Kunin CM Guidelines for improving the use of antimicrobial agents in hospitals: a statement by the Infectious Diseases Society of America. Journal of Infectious Diseases 1988, 157: 869–876.
Speller DCE The clinical impact of antibiotic resistance. Journal of Antimicrobial Chemotherapy 1988, 22: 583–586.
Neu HC Current mechanisms of resistance to antimicrobial agents in microorganisms causing infection in the patient at risk from infection. American Journal of Medicine 1984, 76: 11–27.
Bryan LE General mechanisms of resistance to antibiotics. Journal of Antimicrobial Chemotherapy. 1988, 22 Supplement A: 1–15.
Price DJE, Sleigh JD Control of infection toKlebsiella aerogenes in a neurosurgical unit by withdrawal of all antibiotics. Lancet 1970, ii: 1213–1215.
Richards H, Datta N Transposons and trimethoprim resistance. British Medical Journal 1981, 282: 1118–1119.
Goossens H, van Laethem Y, Levy J, Clumeck N Predicting gentamicin resistance from annual usage in hospital. Lancet 1986, ii: 804–805.
Spencely M, Parker MJ, Dewar RAD, Miller DL The clinical value of microbiological laboratory investigations. Journal of Infection 1979, 1: 23–36.
Moss F, McNicol MW, McSwiggan DA Survey of antibiotic prescribing in a district general hospital. I: Pattern of use. Lancet 1981, ii: 349–352.
Sturm AW Rational prescription of antimicrobial agents and the use of microbiological facilities. Journal of Antimicrobial Chemotherapy 1988, 22: 257–260.
Gould IM Control of antibiotic use in the United Kingdom. Journal of Antimicrobial Chemotherapy 1988, 22: 395–397.
Mouton RP, van Klingeren B (ed Standaardisatie van gevoeligheidsbepalingen. Dutch Infectious Diseases Society, Bilthoven, 1986.
Steers E, Folk EL, Graves BS An inoculum replicating apparatus for routine testing of bacterial susceptibility to antibiotics. Antibiotics and Chemotherapy 1959, 9: 307–311.
Diaz-Metonia F, Harding GKM, Louis TJ, Thomas M, James M, Ronald AR Prospective randomized comparison of imipenem/cilastatin and cefotaxime for treatment of lung, soft tissue and renal infections. Reviews of Infectious Diseases 1985, 7 Supplement 3: 452–457.
Ramirez-Ronda CH, Saavedra S, Rivera-Varquez CR Comparative, double blind study of oral ciprofloxacin and intravenous cefotaxime in skin and skin structure infections. American Journal Medicine 1987, 82: 220–223.
Mandell LA, Bergeron MG, Ronald AR, Vega C, Harding G, Saginur R, Feld R, Duperval R, Landis SJ, Miedzinski LJ, Marrie T, Lalonde RG, Brunton JL, Low DE, Van R Once-daily therapy with ceftriaxone compared with daily multiple-dose therapy with cefotaxime for serious bacterial infections: a randomized, double-blind study. Journal of Infectious Diseases 1989, 169: 433–441.
Weitekamp MR, Aber RC Prolonged bleeding times and bleeding diathesis associated with moxalactam administration. Journal of the American Medical Association 1983, 249: 69–71.
Sanders CC Novel resistance selected by the new expanded-spectrum cephalosporins: a concern. Journal of Infectious Diseases 1983, 14: 585–589.
Pedersen SS, Pressler T, Jensen T, Rosdahl VT, Bentzon MW, Høiby N, Koch C Combined imipenem/cilastatin and tobramycin therapy of multi-resistantPseudomonas aeruginosa in cystic fibrosis. Journal of Antimicrobial Chemotherapy 1987, 19: 101–107.
Brun-Buisson C, Legrand P, Philippon A, Montravers F, Ansquer M, Duval J Transferable enzymatic resistance to third generation cephalosporins during nosocomial outbreak of multi-resistantKlebsiella pneumoniae. Lancet 1987, ii: 302–306.
Courcol R, Pinkas M, Martin GR A seven year survey of antibiotic susceptibility and its relationship with usage. Journal of Antimicrobial Chemotherapy 1989, 23: 441–451.
Mandell LA, Nicolle LE, Ronald A, Landis SJ, Duperval R, Harding GK, Robson HG, Feld R, Vincelette J, Fong I, Goldsand G A prospective randomized trial of ceftazidime versus cefsulodin/tobramycin in the treatment of hospitalized patients with pneumonia. Journal of Antimicrobial Chemotherapy 1987, 20: 95–107.
Smith MD, Bielawska C, Kelsey MC, Rai G, Deaney NB Evaluation of imipenem/cilastatin for treatment of infection in an elderly population. Journal of Antimicrobial Chemotherapy 1988, 21: 481–487.
Martin C, Gouin F, Fourrier F, Junginger W, Prieur BL Pefloxacin in the treatment of nosocomial lower respiratory tract infections in intensive care patients. Journal of Antimicrobial Chemotherapy 1988, 21: 795–799.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Sturm, A.W. Effects of a restrictive antibiotic policy on clinical efficacy of antibiotics and susceptibility patterns of organisms. Eur. J. Clin. Microbiol. Infect. Dis. 9, 381–389 (1990). https://doi.org/10.1007/BF01979466
Issue Date:
DOI: https://doi.org/10.1007/BF01979466