Antimicrobial consumption in five adult intensive care units: a 33-month surveillance study

Abstract

BackgroundEstimating the baseline antimicrobial consumption is extremely important to monitor the impact of antimicrobial stewardship activities that aim to reduce the burden and cost of antimicrobial consumption.ObjectivesTo quantify service-specific antimicrobial consumption using different metrics.MethodsA surveillance study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between October 2012 and June 2015 in five adult intensive care units (ICUs). Consumption data were collected manually on a daily basis by infection control practitioners. Data were presented as defined daily dose (DDD), days of therapy (DOT) per 1000 patient days, and frequency of daily consumption.ResultsA total of 43,970 DDDs and 46,940 DOTs were monitored during 54,116 patient-days. For the most frequently consumed antimicrobials, the consumption of carbapenems, piperacillin/tazobactam, vancomycin, and colistin (respectively) in all ICUs combined were 255.9, 134.3, 98.2, and 13.6 DDDs per 1000 patient-days and 235.7, 145.9, 129.5, and 117.5 DOTs per 1000 patient-days. For the frequency of daily consumption, carbapenems were the most frequently consumed antimicrobial group in medical/surgical, burn, and step-down ICUs while piperacillin/tazobactam was the most frequently consumed antimicrobial in neuro-surgical and cardio-thoracic ICUs.ConclusionHigh consumption of broad-spectrum antimicrobial agents such as meropenem and piperacillin/tazobactam is observed in multiple ICUs in a tertiary care hospital. Meropenem consumption is considerably higher than similar ICUs internationally. Future studies focusing on concurrent monitoring of antimicrobial resistance and identifying patient and physician characteristics associated with specific prescription patterns may help in improving judicious antimicrobial consumption.

Impact of the Audit and Intervention of Infectologists in the Use of Antimicrobials in Intensive Care Units

“…The parenteral route was, in general, the main choice for the administration of antimicrobials, corroborating with the data found in the literature [6,1]. Candeloro CL et al [1] reports that among 90% of prescriptions directed to the parenteral route, only 5.8% were transferred to the enteral route.…”

“…The excessive and long-term use of antimicrobials has led to an increase in the number of adverse events related to drugs, increased health care costs, and, mainly, exerted selective pressure, contributing to microbial resistance, threatening its therapeutic e cacy [1,4,[5][6][7][8][9].…”

Ten-year resistance trends in pathogens causing healthcare-associated infections; reflection of infection control interventions at a multi-hospital healthcare system in Saudi Arabia, 2007–2016

“…Carbapenem resistance in the current study was highest in Acinetobacter and Pseudomonas, which exceeded NHSN figures [21], may reflect the local heavy use of carbapenems, which has been recently documented [34]. Emergence of novel resistant strains and increasing prevalence of high-risk clones has been suggested to explain the increasing carbapenem resistance in Pseudomonas in Saudi Arabia and GCC region [35].…”

“…There was an increasing VRE trend but stable or slightly decreasing MRSA trend during the study. The increasing trends of both CRE and VRE can be at least partially explained by the extensive use of broad-spectrum antimicrobials such as carbapenems, piperacillin/tazobactam, and vancomycin that has been recently documented in our patients [34]. These findings may highlight the need for effective antimicrobial stewardship programs, focusing on education, restrictions, monitoring, and feedback on antimicrobial use and resistance.…”

“…CephR, cephalosporin resistant; CarbR, carbapenem resistant. Solid lines represent pathogens causing all HAI in MNGHA while dotted lines represents pathogens causing CLABSI, VAP, CAUTI, and SSI compiled from the NHSN reports Arabia [43], including the ones on the top of the antimicrobial use list in our ICUs such vancomycin and piperacillin/tazobactam [34].…”