Antimicrobial use, incidence, etiology and resistance patterns in bacteria causing ventilator-associated pneumonia in a clinical-surgical intensive care unit.

Abstract

INTRODUCTION:

Antimicrobial resistance is an increasing threat in hospitalized patients, and inappropriate empirical antimicrobial therapy is known to adversely affect outcomes in ventilator-associated pneumonia (VAP). The aim of this study was to evaluate antimicrobial usage, incidence, etiology, and antimicrobial resistance trends for prominent nosocomial pathogens causing ventilator-associated pneumonia in a clinical-surgical intensive care unit (ICU).

METHODS:

Gram-negative bacilli and Staphylococcus aureus causing VAP, as well as their antimicrobial resistance patterns and data on consumption (defined daily dose [DDD] per 1,000 patient days) of glycopeptides, extended-spectrum cephalosporins, and carbapenems in the unit were evaluated in two different periods (A and B).

RESULTS:

Antimicrobial use was high, mainly of broad-spectrum cephalosporins, with a significant increase in the consumption of glycopeptides (p < 0.0001) and carbapenems (p < 0.007) in period B. For Acinetobacter baumannii and members of the Enterobacteriaceae family, 5.27- and 3.06-fold increases in VAPs, respectively, were noted, and a significant increase in resistance rates was found for imipenem-resistant A. baumannii (p = 0.003) and third-generation cephalosporins-resistant Enterobacteriaceae (p = 0.01) isolates in this same period.

CONCLUSIONS:

Our results suggest that there is a link between antibiotics usage at institutional levels and resistant bacteria. The use of carbapenems was related to the high rate of resistance in A. baumannii and therefore a high consumption of imipenem/meropenem could play a major role in selective pressure exerted by antibiotics in A. baumannii strains.

• Authors: Michel Rodrigues Moreira, Munick Paula Guimarães, Aurélia Aparecida de Araújo Rodrigues, Paulo Pinto Gontijo Filho
• Journal: Revista da Sociedade Brasileira de Medicina Tropical (Rev Soc Bras Med Trop) 2013 Jan-Feb Vol. 46 Issue 1 Pg. 39-44 ISSN: 1678-9849 [Electronic] Brazil
• PMID: 23563823 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents

Topics

• Anti-Bacterial Agents (administration & dosage)
• Critical Care
• Cross-Sectional Studies
• Drug Resistance, Multiple, Bacterial
• Gram-Negative Bacteria (drug effects, isolation & purification)
• Gram-Positive Bacteria (drug effects, isolation & purification)
• Humans
• Inappropriate Prescribing (adverse effects)
• Incidence
• Intensive Care Units (statistics & numerical data)
• Pneumonia, Ventilator-Associated (microbiology)