Antimicrobial consumption, costs and resistance patterns: a two year prospective study in a Romanian intensive care unit.

BACKGROUND: Due to the vulnerable nature of its patients, the wide use of invasive devices and broad-spectrum antimicrobials used, the intensive care unit (ICU) is often called the epicentre of infections. In the present study, we quantified the burden of hospital acquired pathology in a Romanian university hospital ICU, represented by antimicrobial agents consumption, costs and local resistance patterns, in order to identify multimodal interventional strategies. METHODS: Between 1st January 2012 and 31st December 2013, a prospective study was conducted in the largest ICU of Western Romania. The study group was divided into four sub-samples: patients who only received prophylactic antibiotherapy, those with community-acquired infections, patients who developed hospital acquired infections and patients with community acquired infections complicated by hospital-acquired infections. The statistical analysis was performed using the EpiInfo version 3.5.4 and SPSS version 20. RESULTS: A total of 1596 subjects were enrolled in the study and the recorded consumption of antimicrobial agents was 1172.40 DDD/ 1000 patient-days. The presence of hospital acquired infections doubled the length of stay (6.70 days for patients with community-acquired infections versus 16.06/14.08 days for those with hospital-acquired infections), the number of antimicrobial treatment days (5.47 in sub-sample II versus 11.18/12.13 in sub-samples III/IV) and they increased by 4 times compared to uninfected patients. The perioperative prophylactic antibiotic treatment had an average length duration of 2.78 while the empirical antimicrobial therapy was 3.96 days in sample II and 4.75/4.85 days for the patients with hospital-acquired infections. The incidence density of resistant strains was 8.27/1000 patient-days for methicilin resistant Staphylococcus aureus, 7.88 for extended spectrum ß-lactamase producing Klebsiella pneumoniae and 4.68/1000 patient-days for multidrug resistant Acinetobacter baumannii. CONCLUSIONS: Some of the most important circumstances collectively contributing to increasing the consumption of antimicrobials and high incidence densities of multidrug-resistant bacteria in the studied ICU, are represented by prolonged chemoprophylaxis and empirical treatment and also by not applying the definitive antimicrobial therapy, especially in patients with favourable evolution under empirical antibiotic treatment. The present data should represent convincing evidence for policy changes in the antibiotic therapy.

[Antibiotic resistance patterns in Acinetobacter spp. strains isolated from hospital environment]. / Pattern-uri de rezistenta la antibiotice ale unor tulpini de Acinetobacter spp. izolate din mediul spitalicesc.

INTRODUCTION: The Acinetobacter species are ubiquitary germs isolated more and more frequently, Acinetobacter baumannii being currently considered the second strictly aerobic microorganism involved in the ethiology of severe nosocomial infections. Acinetobacter baumannii is usually encountered in surgery and intensive care units, especially in patients with depressed immunity, in which various locations are possible, the most frequvent being the respiratory tract infections, urinary tract infections and bacteriemia. MATERIAL AND METHOD: The study used 52 strains of Acinetobacter spp. isolated from 1131 biological samples (bronchial aspirat, urine, wound secretion, blood, pus, CFS) obtained from the patients of the Timisoara Country Hospital. Identification of germs was performed using the API (BioMerieux) system, and the antibiotics sensitivity testing was made by disk diffusion testing (Kirby-Bauer), with automatic reading and phenotyping through the Osiris Evolution (BioRad) system. RESULTS: The study of resistance to beta-lactamines has pointed out the predominance of penicillinase and cephalosporinase producing strains, 55.77% of the tested ones being part of this phenotype. 90.38% of the strains were resistant to one or more aminoglycosides. Of the tested strains 76.93% were resistant to fluoroquinolones, 86.54% to trimethoprim-sulphamethoxazole, and only 21.15% to tethracycline. CONCLUSIONS: Among the emerging pathogens involved in the nosocomial infections, Acinetobacter baumannii strains have become, in the past decades, a real health issue, due to the variety and seriousness of clinical symptoms. Through the constant increase of the cases number, and the difficulty of applying an effective treatment, the above-mentioned strains showed a multiple resistance to antibiotics.