Background Dissemination of drug-resistant strains is very common in intensive care units (ICU), resulting in combining several antibiotics for prolonged periods. Greece is considered endemic for multi-drug resistant Gram-negative pathogens. An Antibiotics’ Stewardship Programme (ASP), with chief hospital pharmacists to coordinate the stewardship multidisciplinary team, according to national legislation, was activated in March 2017 in our hospital for all clinical departments to initially rationalise the use of crucial protected antibiotics (PA): carbapenems, collistin, tigecycline, linezolid and daptomycin.
Purpose The study was conducted to assess the safety and efficacy of interventions of a restrictive ASP regarding the use of protected antibiotics in the ICU of our hospital in three sequential semesters.
Material and methods Consumption data (volume and value) from ICU for the following antibiotics: carbapenems (meropenem, imipenem/cilastatin, ertapenem), collistin, tigecycline, linezolid and daptomycin were analysed on a monthly basis, regarding the first semester of 2017 (59 patients) and compared to the first (58 patients) and second semester of 2016 (76 patients), before ASP activation. DDDs per 100 bed days (%) were calculated by ABC Calc version 3.1. Mortality rates during hospitalisation, mean in-hospital stay and surveillance results from monitoring resistance in defined bacterial isolates were also available for the relevant semesters.
Results DDD/100 bed days (%) decreased significantly for targeted antibiotics after ASP implementation (e.g. for carbapenems from 50% to 21%, collistin from 71% to 36%, linezolid from 9% to 3%) except for tigecycline that remained at low levels but slightly increased from 1% to 3%. The number of resistant isolates decreased for both Gram (+) and Gram (-) bacteria, mortality rates decreased by 23% and the cost of antimicrobial therapy/bed day in ICU decreased from €58 to €33 between January to June 2016 and 2017.
Conclusion Analysis of data evidence that the ASP implemented consists of safe and efficient interventions for critically ill patients in the ICU and is cost effective for the hospital. The positive results from the ICU can increase conformity from other clinics to the ASP. The stewardship programme should quickly expand by monitoring more procedures in our hospital, such as surgical prophylaxis or use of antifungal pharmacotherapy.
References and/or Acknowledgements To Informatics Technology Department of our hospital for providing bed days and mortality data
No conflict of interest