Antibiotic Use and Resistance at Intensive Care Unit of a Regional Public Hospital in Bali: A 3-Year Ecological Study

Antibiotic resistance at Intensive Care Unit (ICU) has been impacted by several factors, including high utilization and selectivity. The consumption rate and its selective pressure appear very extensive, with regular opportunities for cross-transmissions. In addition, ICU patients are susceptible to carriage acquisition and subsequent infections with high resistant bacteria. Therefore, this study investigates the relationship between the use and resistance of antibiotics in the ICU of a regional public hospital. The results potentially serve as confirmations for planning programs necessary to control ICU-related antibiotic consumption levels. This ecological analysis was also based on inpatient retrospective data from a regional public hospital in Bali from 2017–2019. Subsequently, the amount of intake expressed as daily doses (DDDs) per 100 patient days, and percentage of resistant bacterial isolates were examined using Spearman rank correlation. The largest segment of the antibiotics was determined by drug utilization 90% (DU90%) and the phenotypic class was defined by Centers for Disease Control and Prevention (CDC). Similarly, the most predominantly applied antibiotics were levofloxcacin, ceftriaxone, ampicillin, cefotaxime, ciprofloxacin, ampicillin-sulbactam and gentamycin. Meanwhile, the major gram-negative bacteria were Acinetobacter baumannii, Enterobacter cloacae, Enterococcus faecalis, Escherichia coli, Klebsiella pneumonia and Pseudomonas aeruginosa. Furthermore, 5 multi drug resistant (MDR) bacteria were observed, including A. baumannii, E. cloacae, E. coli, K. pneumonia and P. aeruginosa, while A. baumannii and E. cloacae occurred as carbapenem resistant (CR) and extended-spectrum cephalosporin-resistant (ESCR), respectively. However, only E. coli showed a negative significant correlation between antibiotic utilization and the percentage of ICU bacterial sensitivity (r=–0,543; p=0,024). Therefore, higher consumption of antibiotics decreases its percentage susceptibility.

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BACTERIAL AND SENSITIVITY PATTERN OF PATHOGENS CAUSING VENTILATOR-ASSOCIATED PNEUMONIA IN INTENSIVE CARE UNIT

Majalah Biomorfologi ◽

10.20473/mbiom.v32i1.2022.22-28 ◽

2022 ◽

Vol 32 (1) ◽

pp. 22

Author(s):

Marsheila Harvy Mustikaningtyas ◽

Bambang Pujo Semedi ◽

Kuntaman Kuntaman

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Stay ◽

High Mortality ◽

Length Of Hospital Stay ◽

Resistant Bacteria ◽

Ventilator Associated Pneumonia ◽

E Coli ◽

Sensitivity Pattern ◽

Sensitivity Rate

Highlight:1. Antimicrobial resistance bacteria isolated from VAP patients are often associated with high mortality and length of hospital stay. 2. Mortality in VAP patients was 33.3% and the VAP group had a longer hospital stay compared to the non-VAP group. 3. The three most predominant bacteria that were found were A. baumannii, P. aeruginosa, K. pneumoniae. Cefoperazone-sulbactam, meropenem and amikacin were more than 70% sensitive against these bacteria.Abstract:Background: Ventilator-Associated Pneumonia (VAP) is the most common nosocomial infection in Intensive Care Unit (ICU). Antimicrobial resistant bacteria isolated from VAP patients are often associated with high mortality and length of hospital stay. Objective: This study aimed to analyze the pattern and sensitivity among pathogens that caused VAP in ICU. Materials and Methods: The study was conducted retrospectively by extracting the data of bacterial isolates from sputum specimens in the Laboratory of Clinical Microbiology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia and confirming the clinical data on patients suffering from VAP in ICU ward. The study started from January until December 2017. Results: The total 148 pathogens were isolated, 18 of them were diagnosed as VAP, and 130 were not VAP. The most predominant isolates in the VAP group were Acinetobacter baumannii as many as 38 (9%) followed by Pseudomonas aeruginosa 22 (2%), E. coli 16 (7%), and Klebsiella pneumoniae 11 (1%). The pathogens showed a sensitivity rate above 70% to cefoperazone-sulbactam (SCF), meropenem (MEM) and amikacin (AK). Mortality in VAP patients was 33.3% and the VAP group had a longer hospital stay compared to non-VAP group. Conclusion: The three most predominant bacteria that were found were A. baumannii, P. aeruginosa, K. pneumoniae. The pathogens had sensitivity rate above 70% to cefoperazone-sulbactam, meropenem, and amikacin.

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Community Origin and Previous Use of Antimicrobials Increase the Risk of Nosocomial Multidrug-resistant Bacteria Colonisation in the Intensive Care Unit in a Brazilian Hospital

The Open Public Health Journal ◽

10.2174/1874944501912010449 ◽

2019 ◽

Vol 12 (1) ◽

pp. 449-454

Author(s):

Debora Vandresen ◽

Maria Helena B. Werlang ◽

Mirian Carla B. Silva ◽

Juliana S. Link ◽

Paulo Cezar N. Fortes

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Antibiotic Use ◽

Multidrug Resistant ◽

Resistant Bacteria ◽

Antibiotic Resistant ◽

Beta Lactamases ◽

Hospitalised Patients ◽

Extended Spectrum Beta Lactamases ◽

Hospital Acquired

Background: Hospitalised patients are often surrounded by microorganisms, and antibiotic-resistant pathogens are a major and growing threat to public health. Objective: This study aimed to investigate the epidemiology and the risk factors for colonisation by multidrug-resistant organisms (MDROs) in a Brazilian hospital. Methods: Patients in the Intensive Care Unit (ICU) who underwent nasal and rectal swab cultures for the surveillance of colonisation by MDROs were evaluated in a retrospective study. MDROs were determined by routine microbiological cultures. Results: Of the 785 patients included in this study, 86 presented positive results for MDRO colonisation. Overall, the most frequently isolated organism was Klebsiella pneumoniae (41.9%), followed by Escherichia coli (33.7%). The main type of resistance was the production of extended-spectrum beta-lactamases (ESBL). The prevalence of MDRO infections was significantly associated with the patient's origin (community or hospital-acquired). Having been submitted to previous antimicrobial drug therapy was significantly associated with MDRO infection (relative risk [RR]: 4.02 [2.60 - 6.23]). Conclusion: MDRO ICU colonisation was variable, with similar frequencies as other centres, and important factors, including previous hospital stay and antibiotic use, were closely related to MDRO colonisation. Therefore, control interventions should reduce their rates, especially considering the particularities of each geographic centre.

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1136. Effect of Weekly Antibiotic Rounds as a Core Strategy of the Antimicrobial Stewardship Program on Antibiotic Utilization in a Terciary-care Neonatal Intensive Care Unit, Medellin, Colombia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1329 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S659-S659

Author(s):

Alejandro Diaz Diaz ◽

Juan Gonzalo Mesa-Monsalve ◽

Adriana M Echavarria-Gil ◽

Carolina Jimenez

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Mortality Rate ◽

Hospital Mortality ◽

Neonatal Intensive Care ◽

Antibiotic Prescription ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Days Of Therapy ◽

Prescription Costs

Abstract Background Antibiotics are among the most prescribed drugs in the neonatal intensive care unit (NICU), but frequently are used inappropriately exposing preterm neonates to additional harm. Antibiotic stewardship programs (ASP) have demonstrated impact on antibiotic use in the hospital setting, but implementation in neonatal units is challenging. We sought to determine the effects of weekly antibiotic rounds on overall antibiotic consumption in the NICU. Methods Single-center, retrospective observational study. In November 2014, we implemented weekly antibiotic rounds in a 60-bed tertiary-care NICU, led by a pediatric infectious disease physician. Antibiotic therapy decisions were made in collaboration with neonatologists. Data collected included the proportion of patients receiving antibiotics, irrespective of the indication. Multimodal ASP was implemented hospital-wide in 2015. Antibiotic consumption was measured with days of therapy (DOT). Data on costs and in-hospital mortality were obtained from pharmacy and hospital records. Results From November 2014 to December 2020, we evaluated 13609 neonates admitted to the NICU during rounds. Of those, 3607 (27%) were receiving at least one antibiotic. Overall, the proportion of patients with antibiotics decreased from 31% to 19% during the study period (p< 0.001). In 2017, an outbreak of neonatal necrotizing enterocolitis (NEC) occurred. Specific countermeasures as well as reinforcement of ASP were implemented. Despite Antibiotic usage by DOT increased in 2017 driven by empiric treatment with piperacillin tazobactam in patients with NEC, overall antibiotic consumption decreased from 254.4 DOT/1000 patient days (PD) to 162.4 DOT/1000 PD (Figure 1). Annual costs from antibiotic prescriptions were US&23,161 in 2015 and decreased to US&12.046 in 2020 saving over US&3,800/year (fig 2a). During the study period, we did not observe an increase in crude in-hospital mortality rate (Figure 2b). Primary Y axis indicates the proportion of patients with at least one antibiotic prescription during rounds. Secondary Y axis indicates antibiotic consumption by days of therapy metrics. Antibiotic prescription costs and NICU mortality rates during study period A. Annual antibiotic prescription costs; B. NICU mortality rate Conclusion Weekly antibiotic rounds led to a significant decrease in antibiotic utilization in our NICU. This strategy is relatively simple and low-cost, saves hospital resources and has a large impact on antibiotic use. Hence, its implementation is encouraged as part of successful antimicrobial stewardship programs. Disclosures All Authors: No reported disclosures

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Transmission of a Klebsiella pneumoniae clone harbouring genes for CTX-M-15-like and SHV-112 enzymes in a neonatal intensive care unit of a Kuwaiti hospital

Journal of Medical Microbiology ◽

10.1099/jmm.0.019208-0 ◽

2010 ◽

Vol 59 (6) ◽

pp. 687-692 ◽

Cited By ~ 22

Author(s):

Ali A. Dashti ◽

Mehrez M. Jadaon ◽

Huda H. Gomaa ◽

Bobby Noronha ◽

Edet E. Udo

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Healthcare Workers ◽

Neonatal Intensive Care ◽

Genetic Relatedness ◽

Diffusion Method ◽

Resistant Bacteria ◽

Klebsiella Pneumonia ◽

Disc Diffusion

The spread of antibiotic-resistant bacteria has become a large problem in most countries including Kuwait. This antibiotic resistance is usually due to the production of extended-spectrum β-lactamase (ESBL) enzymes such as SHV, TEM and CTX-M. This study reports the emergence and spread of an ESBL-producing Klebsiella pneumoniae clone in a neonatal intensive care unit (NICU) in a Kuwaiti hospital. Eight ESBL-producing K. pneumoniae isolates were from blood cultures of seven neonates, and two were from the fingers of two healthcare workers in a NICU in Al Jahra Hospital, Kuwait. All isolates were obtained in February–March 2006, except for one, which was obtained in August 2005. Identification of the bacteria was based on traditional bacteriological and biochemical tests using the Vitek system. Antibiotic susceptibility was tested by the disc diffusion method using 16 different antibiotics. ESBLs were detected using disc approximation and double-disc synergy methods and confirmed as ESBLs using Etest. PCR and DNA sequencing were performed to determine the genotypes and mutations in the β-lactamase genes (bla TEM, bla SHV and bla CTX-M). Genetic relatedness was determined by PFGE. All isolates were confirmed to have ESBLs by the Vitek system, disc approximation test, double-disc diffusion test and Etest, being resistant to cefotaxime, ceftazidime, cefepime, gentamicin, tobramycin and ciprofloxacin but susceptible to tetracycline and trimethoprim–sulfamethoxazole. Molecular studies showed the isolates to have TEM-1 β-lactamase, a CTX-M-15-like ESBL and the newly discovered SHV-112 ESBL. PFGE showed that all isolates had identical banding patterns. The results indicate that a single clone of ESBL-producing K. pneumoniae caused bloodstream infections among babies in a NICU of a Kuwaiti hospital, and may have emerged at least 5 years ago. This clone was also present on the hands of healthcare workers, suggesting that they may have been involved in its transmission. Further studies are recommended to determine whether this clone is also spreading in other Kuwaiti hospitals.

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Risk of drug resistance and repeated infection with Klebsiella pneumoniae and Escherichia coli in intensive care unit cancer patients

Combinatorial Chemistry & High Throughput Screening ◽

10.2174/1386207324666210121104724 ◽

2021 ◽

Vol 24 ◽

Author(s):

Samah M. Refay ◽

Eman H. Ahmed ◽

Ahmed R. Abd ELzaher ◽

Ahmed M. Morsy ◽

Manal M. Yasser ◽

...

Keyword(s):

Escherichia Coli ◽

Intensive Care Unit ◽

Drug Resistance ◽

Intensive Care ◽

Klebsiella Pneumoniae ◽

Cancer Patients ◽

Resistant Bacteria ◽

E Coli ◽

Repeated Infection ◽

Repeated Infections

Background: Bacterial infection is a frequent complication in cancer and immunocompromised patients. The emergence of antibiotic resistance is a significant health problem and cancer patients are at risk of repeated infections with drug-resistant bacteria. Objective: This investigation aimed to identify predictors of repeat infections of Escherichia coli and Klebsiella pneumoniae and drug resistance in cancer patients admitted to the intensive care unit (ICU) in Upper Egypt. Methods: Blood, urine, sputum, pus, and mouth and nose swabs were collected form patients at the Pediatric Oncology and Medical Oncology ICUs during the period from February 2017 to May 2018. The samples were assessed by antibiotic susceptibility test and further evaluated by genetic testing for the temoniera (TEM) gene of β-lactamase. Samples positive for K. pneumoniae and E. coli were included and isolates positive for other microorganisms were excluded. Results: The study included 107 patients with malignant neoplasms and 136 samples. Repeated infection with K. pneumoniae and E. coli occurred in 31% and 22.45% of patients, respectively. Patients stayed for a longer period in the ICU were more likely to have repeated infections (OR 1.25, 95%CI 1.10-1.44, p=0.001) after control of other confounding factors. The type of malignant neoplasm whether it was hematologic or solid tumor (OR 7.46, 95% CI 2.56-21.7, p=0.0002) and a longer prior stay in the ICU (OR 1.14, 95% CI 1.02-1.28, p=0.025) remained the independent predictors for the drug resistance in the last infection. The TEM type of β-lactamase was encoded in 48.68% and 66.67% of K. pneumoniae and E. coli, respectively. Conclusion: Reinfection with K. pneumoniae and E. coli in patients with cancer can occur as the number of days in the hospital increases. Total prior days spent in the ICU by cancer patients were independently associated with both repeated infections and drug resistance. Samples from patients with hematologic neoplasms were associated with drug resistance.

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The prevalence of congenital cytomegalovirus infection in newborn infants at an intensive care unit in a public hospital

Jornal de Pediatria ◽

10.2223/jped.1436 ◽

2006 ◽

Vol 82 (1) ◽

pp. 46-50 ◽

Cited By ~ 4

Author(s):

Clarissa Schreiner Miura ◽

Ernani Miura ◽

Alice Beatriz Mombach ◽

Marisa Chesky

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Cytomegalovirus Infection ◽

Public Hospital ◽

Newborn Infants ◽

Congenital Cytomegalovirus Infection ◽

Congenital Cytomegalovirus

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Risk of Clostridium difficile-Associated Disease Among Patients Receiving Proton-Pump Inhibitors in a Quebec Medical Intensive Care Unit

Infection Control and Hospital Epidemiology ◽

10.1086/521664 ◽

2007 ◽

Vol 28 (11) ◽

pp. 1305-1307 ◽

Cited By ~ 40

Author(s):

Mathieu Beaulieu ◽

David Williamson ◽

Gilbert Pichette ◽

Jean Lachaine

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Clostridium Difficile ◽

Gastric Acid ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Medical Intensive Care Unit ◽

Antibiotic Use ◽

Medical Intensive Care

Our study was conducted to determine whether use of gastric acid-suppressive agents increased the risk of Clostridium difficile-associated disease (CDAD) in a medical intensive care unit of one of the first hospitals to be threatened by the current CDAD epidemic in Quebec, Canada. Our findings suggest that efforts to determine risk factors for CDAD should focus on other areas, such as older age and antibiotic use.

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Are Surveillance of Resistant Enteric Bacilli and Antimicrobial Usage Among Neonates in a Newborn Intensive Care Unit Useful?

PEDIATRICS ◽

10.1542/peds.68.1.1 ◽

1981 ◽

Vol 68 (1) ◽

pp. 1-4

Author(s):

Robert D. White ◽

Timothy R. Townsend ◽

Maureen A. Stephens ◽

E. Richard Moxon

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Sepsis ◽

Antibiotic Use ◽

Surveillance Data ◽

Effective Control ◽

Antimicrobial Usage ◽

Newborn Intensive Care Unit ◽

Newborn Intensive Care ◽

Colonization Rates

From March 1976 through December 1978, the prevalence of ampicillin- and gentamicin-resistant enteric bacilli was monitored in fecal cultures of neonates in an intensive care unit. Substantial fluctuations in colonization rates were observed which did not correlate with the occurrence of sepsis due to these organisms nor with variations in antibiotic use. This experience suggests that the availability of these surveillance data did not result in more effective control of neonatal sepsis due to enteric bacilli.

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Implementation of a Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: the Optimizing Antibiotic Strategies in Sepsis (OASIS) II Study

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piy113 ◽

2018 ◽

Vol 9 (1) ◽

pp. 36-43 ◽

Cited By ~ 2

Author(s):

Kevin J Downes ◽

Julie C Fitzgerald ◽

Emily Schriver ◽

Craig L K Boge ◽

Michael E Russo ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Bacterial Infection ◽

Pediatric Intensive Care Unit ◽

Bacterial Infections ◽

Pediatric Intensive Care ◽

Antibiotic Use ◽

Antibiotic Administration ◽

Period 2 ◽

Rate Ratios

Abstract Background Biomarkers can facilitate safe antibiotic discontinuation in critically ill patients without bacterial infection. Methods We tested the ability of a biomarker-based algorithm to reduce excess antibiotic administration in patients with systemic inflammatory response syndrome (SIRS) without bacterial infections (uninfected) in our pediatric intensive care unit (PICU). The algorithm suggested that PICU clinicians stop antibiotics if (1) C-reactive protein <4 mg/dL and procalcitonin <1 ng/mL at SIRS onset and (2) no evidence of bacterial infection by exam/testing by 48 hours. We evaluated excess broad-spectrum antibiotic use, defined as administration on days 3–9 after SIRS onset in uninfected children. Incidence rate ratios (IRRs) compared unadjusted excess length of therapy (LOT) in the 34 months before (Period 1) and 12 months after (Period 2) implementation of this algorithm, stratified by biomarker values. Segmented linear regression evaluated excess LOT among all uninfected episodes over time and between the periods. Results We identified 457 eligible SIRS episodes without bacterial infection, 333 in Period 1 and 124 in Period 2. When both biomarkers were below the algorithm’s cut-points (n = 48 Period 1, n = 31 Period 2), unadjusted excess LOT was lower in Period 2 (IRR, 0.53; 95% confidence interval, 0.30–0.93). Among all 457 uninfected episodes, there were no significant differences in LOT (coefficient 0.9, P = .99) between the periods on segmented regression. Conclusions Implementation of a biomarker-based algorithm did not decrease overall antibiotic exposure among all uninfected patients in our PICU, although exposures were reduced in the subset of SIRS episodes where biomarkers were low.

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