The effect of limiting antimicrobial therapy duration on antimicrobial resistance in the critical care setting

Alexandre R Marra; Silvana Maria de Almeida; Luci Correa; Moacyr Silva Jr; Marinês Dalla Valle Martino; Cláudia Vallone Silva; Ruy Guilherme Rodrigues Cal; Michael B Edmond; Oscar Fernando Pavão dos Santos

doi:10.1016/j.ajic.2008.06.008

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The effect of limiting antimicrobial therapy duration on antimicrobial resistance in the critical care setting

Journal article

Peer reviewed

The effect of limiting antimicrobial therapy duration on antimicrobial resistance in the critical care setting

Alexandre R Marra, Silvana Maria de Almeida, Luci Correa, Moacyr Silva Jr, Marinês Dalla Valle Martino, Cláudia Vallone Silva, Ruy Guilherme Rodrigues Cal, Michael B Edmond and Oscar Fernando Pavão dos Santos

American journal of infection control, Vol.37(3), pp.204-209

04/2009

DOI: 10.1016/j.ajic.2008.06.008

PMID: 18986735

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Abstract

Using antimicrobial agents for prolonged periods of time and/or in heavy densities is known to contribute to antimicrobial resistance. A quasiexperimental, before and after study to limit the duration of antimicrobial therapy to 14 days was conducted in a medical-surgical intensive care unit (ICU). An intervention to optimize antimicrobial therapy was performed when antimicrobial agents had been prescribed for more than 14 days. We then compared antimicrobial utilization using the defined daily dose (DDD) per 1000 patient-days, as well as resistance rates in selected organisms in the intervention phase to the previous 10-month period. In the intervention phase, doctors approved to discontinue the antimicrobial therapy before 14 days in 89.8% (415/462) of the prescribed antibiotics in the ICU. Comparing the 2 time periods, we found a reduction in carbapenems (24.5% decrease), vancomycin (14.3% decrease), and cephalosporins (12.2% decrease) in the intervention phase. Imipenem resistance decreased in Acinetobacter baumannii from 88.5% to 20.0% (P <or= .001) and in Klebsiella pneumoniae from 54.5% to 10.7% (P = .01). These results suggest that an intervention to reduce the duration of antimicrobial therapy contributed to more rational use of antimicrobial agents and to the reduction of bacterial resistance in the critical care setting.

Intensive Care Units

Klebsiella pneumoniae - drug effects

Bacterial Infections - drug therapy

Humans

Drug Resistance, Bacterial

Cross Infection - drug therapy

Incidence

Anti-Bacterial Agents - therapeutic use

Time Factors

Bacterial Infections - epidemiology

Acinetobacter baumannii - drug effects

Anti-Bacterial Agents - administration & dosage

Drug Utilization - statistics & numerical data

Cross Infection - epidemiology

Details

Title: Subtitle: The effect of limiting antimicrobial therapy duration on antimicrobial resistance in the critical care setting
Creators: Alexandre R Marra - Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil. a.marra@uol.com.br
Silvana Maria de Almeida
Luci Correa
Moacyr Silva Jr
Marinês Dalla Valle Martino
Cláudia Vallone Silva
Ruy Guilherme Rodrigues Cal
Michael B Edmond
Oscar Fernando Pavão dos Santos
Resource Type: Journal article
Publication Details: American journal of infection control, Vol.37(3), pp.204-209
Publisher: United States
DOI: 10.1016/j.ajic.2008.06.008
PMID: 18986735
ISSN: 0196-6553
eISSN: 1527-3296
Language: English
Date published: 04/2009
Academic Unit: Internal Medicine
Record Identifier: 9983905532202771

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