Original scientific paper

Impact of Aminoglycoside Cycling in Six Tertiary Intensive Care Units: Prospective Longitudinal Interventional Study

Igor Francetić ; Department of Internal Medicine, Zagreb University Hospital Center, Zagreb, Croatia
Smilja Kalenić ; Department of Clinical and Molecular Microbiology, Zagreb, University Hospital Center, Zagreb, Croatia
Mirjana Huić ; Department of Internal Medicine, Zagreb University Hospital Center, Zagreb, Croatia
Iveta Merčep ; Department of Internal Medicine, Zagreb University Hospital Center, Zagreb, Croatia
Ksenija Makar-Aušperger ; Department of Internal Medicine, Zagreb University Hospital Center, Zagreb, Croatia
Robert Likić ; Department of Internal Medicine, Zagreb University Hospital Center, Zagreb, Croatia
Viktorija Erdeljić ; Department of Internal Medicine, Zagreb University Hospital Center, Zagreb, Croatia
Vesna Tripković ; Department of Clinical and Molecular Microbiology, Zagreb, University Hospital Center, Zagreb, Croatia
Petra Šimić ; Department of Internal Medicine, Zagreb University Hospital Center, Zagreb, Croatia

Abstract

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.

Keywords

aminoglycoside; gentamicin; amikacin; netilmicin; resistance; gram-negative bacteriemia; cost; intensive care unit

Hrčak ID:

26157

URI

https://hrcak.srce.hr/26157

Publication date:

15.4.2008.

Article data in other languages: croatian

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