Repozitorij Medicinskog fakulteta Sveučilišta u Zagrebu

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.

    Item Type: Article
    MeSH: Amikacin - administration & dosage - therapeutic use ; Aminoglycosides - administration & dosage - therapeutic use ; Drug Resistance, Multiple, Bacterial - drug effects ; Gentamicins - administration & dosage - therapeutic use ; Gram-Negative Bacterial Infections - drug therapy - economics ; Intensive Care Units - statistics & numerical data ; Netilmicin - administration & dosage - therapeutic use ; Sepsis - drug therapy - economics ; Anti-Bacterial Agents - administration & dosage - therapeutic use ; Cost-Benefit Analysis ; Croatia ; Humans ; Longitudinal Studies ; Prospective Studies
    Divisions: Uredništvo časopisa Croatian Medical Journal
    Katedra za internu medicinu
    Katedra za anatomiju i kliničku anatomiju
    Katedra za bakteriologiju, virologiju i parasitologiju
    Depositing User: Lea Škorić
    Status: Published
    Creators:
    CreatorsEmail
    Francetić, Igor
    Kalenić, Smilja
    Huić, Mirjana
    Merčep, Iveta
    Makar-Aušperger, Ksenija
    Likić, Robert
    Erdeljić, Viktorija
    Tripković, Vesna
    Šimić, Petra
    Date: April 2008
    Date Deposited: 15 May 2008
    Last Modified: 23 Sep 2011 18:10
    Subjects: /
    Related URLs:
      URI: http://medlib.mef.hr/id/eprint/370

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