Evaluating the long-term impact of an antimicrobial stewardship programme in a Central London mixed medical and surgical intensive care unit.
JAC Antimicrob Resist
; 4(5): dlac108, 2022 Oct.
Article
em En
| MEDLINE
| ID: mdl-36226228
ABSTRACT
Background:
Antimicrobial overuse causes increased antimicrobial resistance in ICUs; antimicrobial stewardship programmes (ASPs) aim to optimize usage. Following an MDR Acinetobacter baumannii (MRAb) outbreak in 2008, an ASP was implemented at a London ICU, and then continued as a long-term programme. This study aimed to determine long-term changes in antimicrobial prescribing 9â years on.Methods:
Data were collected from ICU patients in 2008 immediately before ASP implementation, and thereafter for 6â month cohort periods in 2010-2011, 2012 and 2017. Antimicrobial usage in DDD per 1000 occupied bed days (OBD) were compared. Multivariate linear regression models for antimicrobial days were fitted, adjusting for APACHE II score and patient days. Antimicrobial resistance in Pseudomonas aeruginosa (as an indicator organism) was compared across cohort periods.Findings:
Across 400 patients over 9â years, antimicrobial use changed significantly (Pâ<â0.011) and remained lower in all post-ASP cohorts compared with pre-ASP [(2008; 1827â DDD/1000â OBD), (2010; 1264â DDD/1000â OBD), (2012; 1270â DDD/1000â OBD) and (2017; 1566â DDD/1000â OBD)]. There was reduction in usage of all antimicrobial classes except ß-lactams (where there was no significant increase nor decrease, Pâ=â0.178) and aminoglycosides (where there was a significant increase in usage, Pâ<â0.0001). The latter was temporally associated with restrictions on specific carbapenems. There was an increase in carbapenem-resistant P. aeruginosa in 2012 only (Pâ=â0.028) but not subsequently.Conclusions:
Following ASP implementation after an outbreak of MRAb, reduced antimicrobial prescribing was maintained 9â years on. We identify several factors influencing successful long-term maintenance of ASPs in ICUs.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Prognostic_studies
Idioma:
En
Revista:
JAC Antimicrob Resist
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Reino Unido