Antimicrobial resistance and antibiotic consumption in intensive care units, Switzerland, 2009 to 2018

Background Intensive care units (ICU) constitute a high-risk setting for antimicrobial resistance (AMR). Aim We aimed to describe secular AMR trends including meticillin-resistant Staphylococcus aureus (MRSA), glycopeptide-resistant enterococci (GRE), extended-spectrum cephalosporin-resistant Escherichia coli (ESCR-EC) and Klebsiella pneumoniae (ESCR-KP), carbapenem-resistant Enterobacterales (CRE) and Pseudomonas aeruginosa (CRPA) from Swiss ICU. We assessed time trends of antibiotic consumption and identified factors associated with CRE and CRPA. Methods We analysed patient isolate and antibiotic consumption data of Swiss ICU sent to the Swiss Centre for Antibiotic Resistance (2009–2018). Time trends were assessed using linear logistic regression; a mixed-effects logistic regression was used to identify factors associated with CRE and CRPA. Results Among 52 ICU, MRSA decreased from 14% to 6% (p = 0.005; n = 6,465); GRE increased from 1% to 3% (p = 0.011; n = 4,776). ESCR-EC and ESCR-KP increased from 7% to 15% (p < 0.001, n = 10,648) and 5% to 11% (p = 0.002; n = 4,052), respectively. CRE, mostly Enterobacter spp., increased from 1% to 5% (p = 0.008; n = 17,987); CRPA remained stable at 27% (p = 0.759; n = 4,185). Antibiotic consumption in 58 ICU increased from 2009 to 2013 (82.5 to 97.4 defined daily doses (DDD)/100 bed-days) and declined until 2018 (78.3 DDD/100 bed-days). Total institutional antibiotic consumption was associated with detection of CRE in multivariable analysis (odds ratio per DDD: 1.01; 95% confidence interval: 1.0–1.02; p = 0.004). Discussion In Swiss ICU, antibiotic-resistant Enterobacterales have been steadily increasing over the last decade. The emergence of CRE, associated with institutional antibiotic consumption, is of particular concern and calls for reinforced surveillance and antibiotic stewardship in this setting.

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Trends in antibiotic consumption in Colombian intensive care units, 2010-2017 v1

10.17504/protocols.io.byktpuwn ◽

2021 ◽

Author(s):

Jorge not provided not provided Machado Alba

Keyword(s):

Intensive Care ◽

Clinical Practice ◽

Intensive Care Units ◽

Practice Guidelines ◽

Antibiotic Use ◽

Descriptive Study ◽

Antibiotic Consumption ◽

Defined Daily Doses ◽

Bed Days ◽

The Cost

Trends in antibiotic consumption in Colombian intensive care units, 2010-2017 Introduction: Antibiotics are frequently used in intensive care units (ICUs). The objective of this study was to describe the trends of antibiotic use in Colombian ICUs across 8 years. Methods: This was a descriptive study that analyzed the consumption of antibiotics in 11 ICUs in 7 different cities. Patients older than 18 years in the period 2010 to 2017 were included. Demographic, pharmacological and cost variables were analyzed. Results: A total of 31,886 patients (50.8% men), with a mean age of 60.3±19.8 years, were treated with antibiotics. The most widely used antibiotics were piperacillin-tazobactam (25.2%), ampicillin-sulbactam (21.8%), and vancomycin (21.4%). The use of cefepime increased from 5.7 defined daily doses per 100 bed-days (DBD) in 2010 to 11.3 in 2017, followed by the use of meropenem (14.73 to 20.18 DBD). The average cost per patient/day decreased from USD 16.1 to USD 8.0 (reduction of 50.3%). A total of 41.3% of the cost corresponded to meropenem and 25.8% to piperacillin-tazobactam. Conclusions: The antimicrobials used in the ICU correspond to those recommended by the clinical practice guidelines. An increase in the DBD of some cephalosporins, carbapenems and penicillins and a significant reduction in the cost per patient day were observed.

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Factors associated with patient safety in neonatal intensive care units: A multicenter study using ordinal logistic regression

Japan Journal of Nursing Science ◽

10.1111/jjns.12374 ◽

2020 ◽

Author(s):

Mi Yu ◽

Chang Gi Park

Keyword(s):

Logistic Regression ◽

Patient Safety ◽

Intensive Care ◽

Intensive Care Units ◽

Multicenter Study ◽

Neonatal Intensive Care ◽

Ordinal Logistic Regression ◽

Neonatal Intensive Care Units ◽

Factors Associated

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Factors Associated with 90-Day Mortality in Invasively Ventilated Patients with COVID-19 in Marseille, France

Journal of Clinical Medicine ◽

10.3390/jcm10235650 ◽

2021 ◽

Vol 10 (23) ◽

pp. 5650

Author(s):

Maxime Volff ◽

David Tonon ◽

Youri Bommel ◽

Noémie Peres ◽

David Lagier ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Respiratory Failure ◽

Intensive Care Units ◽

Arterial Thrombosis ◽

Invasive Mechanical Ventilation ◽

Multivariable Analysis ◽

Factors Associated ◽

Icu Admission ◽

Ventilated Patients

Objectives: To describe clinical characteristics and management of intensive care units (ICU) patients with laboratory-confirmed COVID-19 and to determine 90-day mortality after ICU admission and associated risk factors. Methods: This observational retrospective study was conducted in six intensive care units (ICUs) in three university hospitals in Marseille, France. Between 10 March and 10 May 2020, all adult patients admitted in ICU with laboratory-confirmed SARS-CoV-2 and respiratory failure were eligible for inclusion. The statistical analysis was focused on the mechanically ventilated patients. The primary outcome was the 90-day mortality after ICU admission. Results: Included in the study were 172 patients with COVID-19 related respiratory failure, 117 of whom (67%) received invasive mechanical ventilation. 90-day mortality of the invasively ventilated patients was 27.4%. Median duration of ventilation and median length of stay in ICU for these patients were 20 (9–33) days and 29 (17–46) days. Mortality increased with the severity of ARDS at ICU admission. After multivariable analysis was carried out, risk factors associated with 90-day mortality were age, elevated Charlson comorbidity index, chronic statins intake and occurrence of an arterial thrombosis. Conclusion: In this cohort, age and number of comorbidities were the main predictors of mortality in invasively ventilated patients. The only modifiable factor associated with mortality in multivariate analysis was arterial thrombosis.

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Surveillance of Antibiotic Prescribing in Intensive Care Units in Poland

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2018/5670238 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Ewa Trejnowska ◽

Aleksander Deptuła ◽

Magda Tarczyńska-Słomian ◽

Piotr Knapik ◽

Miłosz Jankowski ◽

...

Keyword(s):

Health Care ◽

Intensive Care ◽

Intensive Care Units ◽

Antibiotic Treatment ◽

Antibiotic Consumption ◽

Public Health Care ◽

Antibiotic Prescribing ◽

Icu Stay ◽

Defined Daily Doses ◽

Length Of Icu Stay

Antibiotic use and microbial resistance in health care-associated infections are increasing globally and causing health care problems. Intensive Care Units (ICUs) represent the heaviest antibiotic burden within hospitals, and sepsis is the second noncardiac cause of mortality in ICUs. Optimizing appropriate antibiotic treatment in the management of the critically ill in ICUs became a major challenge for intensivists. We performed a surveillance study on the antibiotic consumption in 108 Polish ICUs. We determined which classes of antibiotics were most commonly consumed and whether they affected the length of ICU stay and the size and category of the hospital. A total of 292.389 defined daily doses (DDD) and 192.167 patient-days (pd) were identified. Antibiotic consumption ranged from 620 to 3960 DDD/1000 pd. The main antibiotic classes accounted for 59.6% of the total antibiotic consumption and included carbapenems (17.8%), quinolones (14%), cephalosporins (13.7%), penicillins (11.9%), and macrolides (2.2%), respectively, whereas the other antibiotic classes accounted for the remainder (40.4%) and included antifungals (34%), imidazoles (20%), aminoglycosides (18%), glycopeptides (15%), and polymyxins (6%). The most consumed antibiotic classes in Polish ICUs were carbapenems, quinolones, and cephalosporins, respectively. There was no correlation between antibiotic consumption in DDD/1000 patient-days, mean length of ICU stay, size of the hospital, size of the ICU, or the total amount of patient-days. It is crucial that surveillance systems are in place to guide empiric antibiotic treatment and to estimate the burden of resistance. Appropriate use of antibiotics in the ICU should be an important public health care issue.

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Central line-associated bloodstream infections in Australian intensive care units: Time-trends in infection rates, etiology, and antimicrobial resistance using a comprehensive Victorian surveillance program, 2009-2013

American Journal of Infection Control ◽

10.1016/j.ajic.2015.03.036 ◽

2015 ◽

Vol 43 (8) ◽

pp. 848-852 ◽

Cited By ~ 17

Author(s):

Leon J. Worth ◽

Tim Spelman ◽

Ann L. Bull ◽

Judith A. Brett ◽

Michael J. Richards

Keyword(s):

Intensive Care ◽

Antimicrobial Resistance ◽

Intensive Care Units ◽

Time Trends ◽

Bloodstream Infections ◽

Central Line ◽

Surveillance Program ◽

Infection Rates

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Healthcare-associated infections in paediatric and neonatal intensive care units: epidemiology, risk factors and impact of antimicrobial resistance

10.26226/morressier.56d6be7dd462b80296c959b6 ◽

2016 ◽

Author(s):

Laura Folgori

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Antimicrobial Resistance ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Neonatal Intensive Care Units ◽

Healthcare Associated Infections ◽

Healthcare Associated

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PREVALENCE OF CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII (CRAB) IN MEDICAL AND SURGICAL INTENSIVE CARE UNITS (ICUS) OF JPMC, KARACHI

Pakistan Journal of Medicine and Dentistry ◽

10.36283/pjmd8-4/006 ◽

2019 ◽

Author(s):

Rabia Arshad

Keyword(s):

Intensive Care ◽

Antimicrobial Resistance ◽

Acinetobacter Baumannii ◽

Intensive Care Units ◽

Carbapenem Resistance ◽

Chronic Obstructive ◽

Surgical Intensive Care ◽

Carbapenem Resistant ◽

Number Of Patients ◽

Increased Risk

Background: Antimicrobial resistance is one of the research priorities of health organizations due to increased risk of morbidity and mortality. Outbreaks of nosocomial infections caused by carbapenem-resistant Acinetobacter Baumannii (CRAB) strains are at rise worldwide. Antimicrobial resistance to carbapenems reduces clinical therapeutic choices and frequently led to treatment failure. The aim of our study was to determine the prevalence of carbapenem resistance in A. baumannii isolated from patients in intensive care units (ICUs). Methods: This cross-sectional study was carried out in the Department of Microbiology, Basic Medical Sciences Institute (BMSI), Jinnah Postgraduate Medical Centre (JPMC), Karachi, from December 2016 to November 2017. Total 63 non-repetitive A. baumannii were collected from the patients’ specimens, admitted to medical and surgical ICUs and wards of JPMC, Karachi. The bacterial isolates were processed according to standard microbiological procedures to observe for carbapenem resistance. SPSS 21 was used for data analysis. Results: Out of the 63 patients, 40 (63.5%) were male. The age of the patient ranged from 15-85 year, with average of 43 year. 34.9% patients had been hospitalized for 3 days. Chronic obstructive pulmonary disease was present in highest number with average of 58.7% for morbidity. Number of patients on mechanical ventilation was highest (65.1%). All isolates were susceptible to colistin. The resistance to ampicillin-sulbactam, ceftazidime, ciprofloxacin, amikacin, piperacillin- tazobactam and meropenem was 82.5%, 81%, 100%, 87.3%, 82.5% and 82% respectively. Out of 82% CRAB, 77% were obtained from ICUs. Conclusion: This study has revealed the high rate of carbapenem resistance in A. baumannii isolates in ICUs thus leaving behind limited therapeutic options.

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