Impact of aminoglycoside cycling in six tertiary intensive care units: prospective longitudinal interventional study

Francetić, Igor and Kalenić, Smilja and Huić, Mirjana and Merčep, Iveta and Makar-Aušperger, Ksenija and Likić, Robert and Erdeljić, Viktorija and Tripković, Vesna and Šimić, Petra (2008) Impact of aminoglycoside cycling in six tertiary intensive care units: prospective longitudinal interventional study. Croatian Medical Journal, 49 (2). pp. 207-214. ISSN 0353-9504 (Print) 1332-8166 (Electronic)

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Croatian abstract

CILJ: Analizirati utjecaj ciklične primjene aminoglikozida u 6 tercijarnih odjela intenzivne skrbi na stopu pojave sepse, obrazac otpornosti na aminoglikozide, potrošnju antibiotika i troškove. ----- POSTUPCI: Ova prospektivna longitudinalna intervencijska studija mjerila je utjecaj prelaska s uporabe gentamicina (veljača 2002-veljača 2003) na amikacin (veljača 2003-veljača 2004) na obrazac otpornosti na aminoglikozide, broj bolesnika s gram-negativnom bakteremijom, potrošnju antibiotika, i trošak antimikrobnih lijekova na 6 tercijarnih odjela intenzivne skrbi u Zagrebu, Hrvatska. ----- REZULTATI: Prelazak s uporabe gentamicina na amikacin je doveo do pada ukupne otpornosti na gentamicin gram-negativnih bakterija (GNB) sa 42% na 26% (P<0,001; z-test proporcija) i otpornosti na netilmicin s 33% na 20% (P<0,001), ali se otpornost na amikacin nije značajano promijenila (P=0.462), osim kod Acinetobacter baumanni (P=0,014). Stopa pojave sepse na odjelu intezivne skrbi je smanjena s 3,6% na 2,2% (P<0,001; χ2 test), uz smanjenje broja bolničkih krvnih infekcija s 55/100 bolesničkih dana na 26/100 bolesničkih dana (P=0,001, χ2 test). Uporaba amikacina dovela je do 16-postotnog smanjenja u ukupnoj potrošnji antibiotika i smanjenju troškova za € 0,1 po pacijentu po danu. ----- ZALJUČAK: Uporaba amikacina značajno je smanjila otpornost GNB izolata na gentamicin i netilmicin, broj GNB bolničkih bakteremija, i troškove potrošnje antibiotika na odjelima intenzivne skrbi.

English 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; chi(2) test), with a decline in the number of nosocomial bloodstream infections from 55/100 patient-days to 26/100 patient-days (P=0.001, chi(2) test). Furthermore, amikacin use led to a 16% decrease in the overall antibiotic consumption and 0.1 euro/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.

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