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Impact of Aminoglycoside Cycling in Six Tertiary Intensive Care Units: Prospective Longitudinal Interventional Study
Igor Francetić
; Zavod za internu medicinu, Klinički bolnički centar Zagreb
Smilja Kalenić
; Zavod za kliničku i molekularnu mikrobiologiju, Klinički bolnički centar Zagreb, Hrvatska
Mirjana Huić
; Zavod za internu medicinu, Klinički bolnički centar Zagreb
Iveta Merčep
; Zavod za internu medicinu, Klinički bolnički centar Zagreb
Ksenija Makar-Aušperger
; Zavod za internu medicinu, Klinički bolnički centar Zagreb
Robert Likić
; Zavod za internu medicinu, Klinički bolnički centar Zagreb
Viktorija Erdeljić
; Zavod za internu medicinu, Klinički bolnički centar Zagreb
Vesna Tripković
; Zavod za kliničku i molekularnu mikrobiologiju, Klinički bolnički centar Zagreb, Hrvatska
Petra Šimić
; Zavod za internu medicinu, Klinički bolnički centar Zagreb
Sažetak
Aim To determine the effect of aminoglycoside cycling in six tertiary
intensive care units (ICU) on the rates of sepsis, aminoglycoside resistance
patterns, antibiotic consumption, and costs.
Methods This was a prospective longitudinal interventional study that
measured the effect of change from first-line gentamicin usage (February
2002-February 2003) to amikacin usage (February 2003-February
2004) on the aminoglycoside resistance patterns, number of patients
with gram-negative bacteremia, consumption of antibiotics, and the
cost of antimicrobial drugs in 6 tertiary care ICUs in Zagreb, Croatia.
Results The change from first-line gentamicin to amikacin usage led
to a decrease in the overall gentamicin resistance of gram-negative bacteria
(GNB) from 42% to 26% (P<0.001; z-test of proportions) and
netilmicin resistance from 33% to 20% (P<0.001), but amikacin resistance
did not change significantly (P = 0.462), except for Acinetobacter
baumanni (P = 0.014). Sepsis rate in ICUs was reduced from 3.6% to
2.2% (P<0.001; χ2 test), with a decline in the number of nosocomial
bloodstream infections from 55/100 patient-days to 26/100 patientdays
(P = 0.001, χ2 test). Furthermore, amikacin use led to a 16% decrease
in the overall antibiotic consumption and € 0.1/patient/d cost
reduction.
Conclusion Exclusive use of amikacin significantly reduced the resistance
of GNB isolates to gentamicin and netilmicin, the number of
GNB nosocomial bacteremias, and the cost of total antibiotic usage
in ICUs.
Ključne riječi
aminoglycoside; gentamicin; amikacin; netilmicin; resistance; gram-negative bacteriemia; cost; intensive care unit
Hrčak ID:
26157
URI
Datum izdavanja:
15.4.2008.
Posjeta: 1.261 *