Skip to main content

Advertisement

SpringerLink
Log in

A three-point time series study of antibiotic usage on an intensive care unit, following an antibiotic stewardship programme, after an outbreak of multi-resistant Acinetobacter baumannii

  • Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Antibiotic use in intensive care units (ICUs) can promote antimicrobial resistance. Outbreaks of multi-resistant bacteria significantly affect patient outcomes and delivery of care. Antibiotic stewardship programmes (ASPs), combining root-cause analyses and multi-faceted prevention strategies, are necessary, often at significant cost and time. Which elements of such strategies have the largest impact on antibiotic usage following an outbreak is unclear. The aim of this study was to investigate how antibiotic usage in a university hospital ICU changed with a non-protocolised ASP following a disruptive outbreak of multi-resistant Acinetobacter baumannii (MRAB). This was a three time-period observational cohort study. The primary endpoint was the change in overall antibiotic usage (daily defined dose, DDD, antibiotic-days, antibiotic-courses) for consecutive ICU patients staying >48 h, over three 6-month study time periods pre-MRAB (2008, n = 84) and post-MRAB (2010, n = 88; 2012, n = 122). Secondary endpoints were changes in antibiotic usage and patient demographics, in predefined admission categories (Medical Emergency, ME; Surgical Elective, SEL; and Surgical Emergency, SE). The mean age (54.6 ± 17.7, 58.1 ± 17.9, 62.8 ± 19.1 years*) and severity of illness (APACHE 14.8 ± 8.0, 16.7 ± 6.8, 18.3 ± 6.1*) increased, particularly medical admissions. There was a sustained reduction in DDD antibiotic usage [1895.1 (2008), 1224.2 (2010), 1236.6 (2012) per 1000 patient-days] but no overall change in antibiotic-days or antibiotic-courses. Antibiotic usage (antibiotic-days) fell significantly in surgical emergency admissions [20.2 ± 32.1, 4.6 ± 7.4*, 5.9 ± 7.3]. There was a sustained drop in beta-lactam, quinolone, glycopeptide and macrolide usage. Following an MRAB outbreak, and subsequent operational changes including enhanced ASPs (non-protocolised), there was a sustained overall fall in antibiotic usage in spite of an increase in disease severity over 5 years.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. World Health Organization (WHO) (2014) Antimicrobial resistance: global report on surveillance: 2014 summary. Available online at: http://www.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf

  2. Brusselaers N, Vogelaers D, Blot S (2011) The rising problem of antimicrobial resistance in the intensive care unit. Ann Intensive Care 1:47. doi:10.1186/2110-5820-1-47

    Article  PubMed Central  PubMed  Google Scholar 

  3. Hanberger H, Arman D, Gill H, Jindrák V, Kalenic S, Kurcz A, Licker M, Naaber P, Scicluna EA, Vanis V, Walther SM (2009) Surveillance of microbial resistance in European intensive care units: a first report from the Care-ICU programme for improved infection control. Intensive Care Med 35(1):91–100. doi:10.1007/s00134-008-1237-y

    Article  PubMed  Google Scholar 

  4. Chandrasiri P, Elwitigala JP, Nanayakkara G, Chandrasiri S, Patabendige G, Karunanayaka L, Perera J, Somaratne P, Jayathilleke K (2013) A multi centre laboratory study of Gram negative bacterial blood stream infections in Sri Lanka. Ceylon Med J 58(2):56–61. doi:10.4038/cmj.v58i2.5680

    Article  Google Scholar 

  5. Meyer E, Gastmeier P, Deja M, Schwab F (2013) Antibiotic consumption and resistance: data from Europe and Germany. Int J Med Microbiol 303(6–7):388–395. doi:10.1016/j.ijmm.2013.04.004

    Article  PubMed  Google Scholar 

  6. McKinnell JA, Miller LG, Eells SJ, Cui E, Huang SS (2013) A systematic literature review and meta-analysis of factors associated with methicillin-resistant Staphylococcus aureus colonization at time of hospital or intensive care unit admission. Infect Control Hosp Epidemiol 34(10):1077–1086. doi:10.1086/673157

    Article  PubMed  Google Scholar 

  7. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb S, Beale RJ, Vincent JL, Moreno R; Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39(2):165–228. doi:10.1007/s00134-012-2769-8

    Article  CAS  PubMed  Google Scholar 

  8. Lee HY, Chen CL, Wu SR, Huang CW, Chiu CH (2014) Risk factors and outcome analysis of acinetobacter baumannii complex bacteremia in critical patients. Crit Care Med 42(5):1081–1088. doi:10.1097/CCM.0000000000000125

    Article  CAS  PubMed  Google Scholar 

  9. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G; SCCM/ESICM/ACCP/ATS/SIS (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 31(4):1250–1256

    Article  PubMed  Google Scholar 

  10. Cahill OJ, Claro T, O’Connor N, Cafolla AA, Stevens NT, Daniels S, Humphreys H (2014) Cold air plasma to decontaminate inanimate surfaces of the hospital environment. Appl Environ Microbiol 80(6):2004–2010. doi:10.1128/AEM.03480-13

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Zhang YZ, Singh S (2015) Antibiotic stewardship programmes in intensive care units: why, how, and where are they leading us. World J Crit Care Med 4(1):13–28

    Article  PubMed Central  PubMed  Google Scholar 

  12. Assink-de Jong E, de Lange DW, van Oers JA, Nijsten MW, Twisk JW, Beishuizen A (2013) Stop Antibiotics on guidance of Procalcitonin Study (SAPS): a randomised prospective multicenter investigator-initiated trial to analyse whether daily measurements of procalcitonin versus a standard-of-care approach can safely shorten antibiotic duration in intensive care unit patients—calculated sample size: 1816 patients. BMC Infect Dis 13:178. doi:10.1186/1471-2334-13-178

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgements

We wish to thank the patients and staff of the Intensive Care Unit, Chelsea and Westminster Hospital, who have contributed to the data involved in this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, London, SW10 9NH, UK

    S. Singh, Y. Z. Zhang, S. Chalkley, K. Ananthan, E. Demertzi, M. Beach, M. Cohen, V. Grover, C. Chung, J. Tatlock, N. Soni & B. Azadian

Authors
  1. S. Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Y. Z. Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Chalkley
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. Ananthan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Demertzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Beach
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. V. Grover
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C. Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. J. Tatlock
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. N. Soni
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. B. Azadian
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Singh.

Electronic supplementary material

Below are the links to the electronic supplementary material.

ESM 1

(DOC 35 kb)

ESM 2

(DOC 39 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Singh, S., Zhang, Y.Z., Chalkley, S. et al. A three-point time series study of antibiotic usage on an intensive care unit, following an antibiotic stewardship programme, after an outbreak of multi-resistant Acinetobacter baumannii . Eur J Clin Microbiol Infect Dis 34, 1893–1900 (2015). https://doi.org/10.1007/s10096-015-2429-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-015-2429-3

Keywords

Search

Navigation