Characteristics of infection in intensive care unit before (2007-2010) and after (2011-2014) the beginning of an antimicrobial stewardship program.

OBJECTIVES

To investigate the factors associated with isolates in intensive care unit (ICU) before and after an antimicrobial stewardship program.

MATERIALS

Monocentric retrospective cohort study. Patients admitted to the ICU in 2007-2014 were included. Characteristics of patients were compared to overall ICU population. Clinical and microbiological characteristics of patients before (2007-2010) and after (2011-2014) the beginning of the AMP were compared.

RESULTS

Overall, 5,263 patients were admitted to the ICU, 274/5,263 (5%) had a isolate during their staying. In 2011-2014, the percentage isolates reduced (7% vs 4%, ≤ .0001). Patients with had higher rates of in-hospital death (43% 20%, < .0001) than overall ICU population. In 2011-2014, rates of multidrug-resistant (11% 2%, = .0020), fluoroquinolone-resistant (35% vs 12%, < .0001), and ceftazidime-resistant (23% vs 8%, = .0009) reduced. Treatments by fluoroquinolones (36% vs 4%, ≤ .0001), carbapenems (27% vs 9%, = .0002), and third-generation cephalosporins (49% vs 12, ≤ .0001) before isolation reduced while piperacillin (0% vs 13%, < .0001) and trimethoprim-sulfamethoxazole (8% vs 26%, = .0023) increased. Endotracheal intubation reduced in 2011-2014 (61% vs 35%, < .0001). Fluoroquinolone-resistance was higher in patients who received endotracheal intubation (29% vs 17%, = .0197). Previous treatment by fluoroquinolones (OR = 2.94, = .0020) and study period (2007-2010) (OR = 2.07, = .0462) were the factors associated with fluoroquinolone-resistance at the multivariate analysis.

CONCLUSIONS

Antibiotic susceptibility in isolates was restored after the reduction of endotracheal intubation, fluoroquinolones, carbapenems, and third-generation cephalosporins and the increased use of molecules with a low ecological footprint, as piperacillin and trimethoprim-sulfamethoxazole.