Impact of an antibiotic restriction policy on the antibiotic resistance patterns of Gram-negative microorganisms in an Intensive Care Unit in Greece

Ntagiopoulos, Panagiotis G.; Paramythiotou, Elisabeth; Antoniadou, Anastasia; Giamarellou, Helen; Karabinis, Andréas

doi:10.1016/j.ijantimicag.2007.05.012

Cited by 49 publications

(30 citation statements)

References 15 publications

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“…25,26 Antibiotic restriction policy can significantly reduce antimicrobial consumption and antimicrobial resistance rates. 27 We have demonstrated that neonates with infections due to ESBL K. pneumoniae had a significantly higher mortality than those without ESBL K. pneumoniae infection. Similar findings were reported previously.…”

Section: Discussionmentioning

confidence: 83%

“…Similar findings were reported previously. 27 Inadequate empirical antibiotic therapy was associated with mortality. Prompt initiation of effective antibiotic therapy is essential in neonatal sepsis, and empirical decisions must be based on a sound knowledge of the local distribution of pathogens and their susceptibility patterns in each individual unit.…”

Section: Discussionmentioning

confidence: 99%

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RETRACTED ARTICLE: Extended-spectrum β-lactamase producing Klebsiella pneumoniae in neonatal intensive care unit

et al. 2008

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Objectives: Extended-spectrum beta-lactamase producing (ESBL) Klebsiella pneumoniae is an important cause of nosocomial infections in neonatal intensive care units (NICUs). Our objectives were to determine (1) the incidence of ESBL K. pneumoniae in our NICU, (2) the frequency of SHV-1 and SHV-2 gene acquisition among ESBL K. pneumoniae isolates, (3) the risk factors associated with ESBL K. pneumoniae infection and (4) the clinical outcomes of infected infants.Study Design: We conducted a prospective surveillance study in our NICU over a period of 1 year on all neonates admitted without evidence of early sepsis. We collected specimens from blood, urine, cerebrospinal fluid, swabs from wounds and throat and endotracheal tube aspirates of infants whenever sepsis was suspected. Bacterial isolates were identified via clinical morphology, Gram stain and standard biochemical tests. Antimicrobial susceptibility was determined by disc diffusion method, and phenotypic confirmation of ESBL production was done by the double-disc synergy test and Etest. Genetic detection of SHV-1 and SHV-2 genes in ESBL K. pneumoniae isolates was done by polymerase chain reaction (PCR) and restriction fragment length polymorphisms. Risk factors associated with ESBL K. pneumoniae infection were analysed by both univariate and multiple logistic regression methods.Results: A total of 980 cultures were obtained from 380 neonates, and 372 screening cultures were collected from the environment. K. pneumoniae was cultured from 27 (7%) infants (3.8/1000 patient-days); of them, 18 (67%) were ESBL producers. PCR amplicons revealed the presence of SHV-2 in all 18 isolates (100%), and SHV-1 gene in 8 isolates (44%). Independent risk factors for ESBL K. pneumoniae infection were mechanical ventilation (OR: 4.2, confidence interval (CI): 1.6-11.0); birth weight <1500 g (OR: 3.2, CI: 1.2-8.3) ); duration of hospitalization >15 days (OR: 4

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

RETRACTED ARTICLE: Extended-spectrum β-lactamase producing Klebsiella pneumoniae in neonatal intensive care unit

et al. 2008

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“…Data from several studies [33][34][35] suggests that restricting antimicrobial use, with respect to duration and breadth, can decrease resistance rates. Clearly, with increasing resistance this needs to be a priority.…”

Section: Page 14 Of 33mentioning

confidence: 99%

Nosocomial Gram-negative bacteremia in intensive care: epidemiology, antimicrobial susceptibilities, and outcomes

Sligl

Dragan

Smith

2015

International Journal of Infectious Diseases

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“…These components include audits [57] , infectious disease specialist or senior clinician input [58][59][60][61][62][63][64] , or planned discontinuation/deescalation of treatment in response to clinical and microbiological outcome data [65] . Other components include rotating antibiotic schedules [57,[66][67][68][69][70] changes in prescribing policies involving antibiotic restriction, different dosing regimens or prophylaxis protocols [57,62,65,67,[71][72][73][74][75][76][77][78][79][80][81][82][83][84] and a multi-disciplinary team (MDT) approach in treatment initiation and discontinuation, often emphasising feedback and non-punitive atmosphere among staff members [83,85] . Some programmes also encompassed staff education [57,74,76] and computerised decision support platforms [86][87][88][89][90][91] .…”

Section: Discussionmentioning

confidence: 99%

Antibiotic stewardship programmes in intensive care units: Why, how, and where are they leading us

Zhang

Singh

2015

WJCCM

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Antibiotic usage and increasing antimicrobial resistance (AMR) mount significant challenges to patient safety and management of the critically ill on intensive care units (ICU). Antibiotic stewardship programmes (ASPs) aim to optimise appropriate antibiotic treatment whilst minimising antibiotic resistance. Different models of ASP in intensive care setting, include "standard" control of antibiotic prescribing such as "de-escalation strategies" through to interventional approaches utilising biomarkerguided antibiotic prescribing. A systematic review of outcomes related studies for ASPs in an ICU setting was conducted. Forty three studies were identified from MEDLINE between 1996 and 2014. Of 34 nonprotocolised studies, [1 randomised control trial (RCT), 22 observational and 11 case series], 29 (85%) were positive with respect to one or more outcome: These were the key outcome of reduced antibiotic use, or ICU length of stay, antibiotic resistance, or prescribing cost burden. Limitations of non-standard antibiotic initiation triggers, patient and antibiotic selection bias or baseline demographic variance were identified. All 9 protocolised studies were RCTs, of which 8 were procalcitonin (PCT) guided antibiotic stop/start interventions. Five studies addressed antibiotic escalation, 3 de-escalation and 1 addressed both. Six studies reported positive outcomes for reduced antibiotic use, ICU length of stay or antibiotic resistance. PCT based ASPs are effective as antibiotic-stop (de-escalation) triggers, but not as an escalation trigger alone. PCT has also been effective in reducing antibiotic usage without worsening morbidity or mortality in ventilator associated pulmonary infection. No study has demonstrated survival benefit of ASP. Ongoing challenges to infectious disease management, reported by the World Health Organisation global report 2014, are high AMR to newer antibiotics, and regional knowledge gaps in AMR surveillance. Improved AMR surveillance data, identifying core aspects of successful ASPs that are transferable, and further well-conducted trials will be necessary if ASPs are to be an effective platform for delivering desired patient outcomes and safety through best antibiotic policy.

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Impact of an antibiotic restriction policy on the antibiotic resistance patterns of Gram-negative microorganisms in an Intensive Care Unit in Greece

Cited by 49 publications

References 15 publications

RETRACTED ARTICLE: Extended-spectrum β-lactamase producing Klebsiella pneumoniae in neonatal intensive care unit

RETRACTED ARTICLE: Extended-spectrum β-lactamase producing Klebsiella pneumoniae in neonatal intensive care unit

Nosocomial Gram-negative bacteremia in intensive care: epidemiology, antimicrobial susceptibilities, and outcomes

Antibiotic stewardship programmes in intensive care units: Why, how, and where are they leading us

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