Antonella Frattari1, Vincenzo Savini2, Ennio Polilli3, Graziano Di Marco4, Giuseppe Lucisano5, Serena Corridoni6, Tullio Spina1, Alberto Costantini6, Antonio Nicolucci5, Paolo Fazii2, Pierluigi Viale7, Giustino Parruti8. 1. Unit of Anesthesia and Intensive Care, Pescara General Hospital, Pescara, Italy. 2. Unit of Clinical Microbiology, Pescara General Hospital, Pescara, Italy. 3. Unit of Clinical Pathology, Pescara General Hospital, Pescara, Italy. 4. Unit of Management Control, Local Health Unit Direction, Pescara General Hospital, Pescara, Italy. 5. Unit of Biostatistics, CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy. 6. Hospital Pharmacy, Pescara General Hospital, Pescara, Italy. 7. Cathedra of Infectious Diseases, Alma Mater University, Boulogne, Italy. 8. Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy. Electronic address: parruti@tin.it.
Abstract
BACKGROUND: Gram-negative Multi-Drug-Resistant Organisms (GNMDROs) cause an increasing burden of disease in Intensive Care Units (ICUs). We deployed a multifaceted intervention to control selection and transmission of GNMDROs and to estimate at which rate GNMDROs would decline with our interventional bundle. METHODS: Interventions implemented in 2015: in-ward Antimicrobial-Stewardship-Program for appropriate management of antimicrobial prescription; infection monitoring with nasal/rectal swabs and repeated procalcitonin assays; 24 h microbiological support (since 2016); prevention of catheter-related infections, VAPs and in-ward GNMDROs transmission; education of ICU personnel. In May 2017, epidemiological, clinical and microbiological data were collected and retrospectively analyzed. Rates of resistance in Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii, as well as percentages of resistance among all Gram-negative bacteria were compared during the study period. RESULTS: Of 668 patients, at least one isolate was obtained from 399 patients. The proportions of patients with infection and with Gram-negative isolates were even across the 5 semesters (p = 0.8). For Klebsiella pneumoniae, the number of strains resistant to carbapenems fell from 94% to 6% (p < 0.001). Significant drops were also observed for Pseudomonas aeruginosa and Acinetobacter baumannii. Percentages of resistance for all Gram-negative isolates fell from 91% to 13% (p < 0.0001). The reduction in antibiotic prescription translated in a considerable reduction of pharmacy costs. Multivariate models confirmed that the hospitalization semester was the most relevant independent predictor of resistance among Gram-negative bacteria. CONCLUSIONS: Our experience provides further evidence that a multi-faceted intervention, aimed to reduce selection and transmission of GNMDROs with efficient microbiological support, may yield remarkable results in a short time interval.
BACKGROUND: Gram-negative Multi-Drug-Resistant Organisms (GNMDROs) cause an increasing burden of disease in Intensive Care Units (ICUs). We deployed a multifaceted intervention to control selection and transmission of GNMDROs and to estimate at which rate GNMDROs would decline with our interventional bundle. METHODS: Interventions implemented in 2015: in-ward Antimicrobial-Stewardship-Program for appropriate management of antimicrobial prescription; infection monitoring with nasal/rectal swabs and repeated procalcitonin assays; 24 h microbiological support (since 2016); prevention of catheter-related infections, VAPs and in-ward GNMDROs transmission; education of ICU personnel. In May 2017, epidemiological, clinical and microbiological data were collected and retrospectively analyzed. Rates of resistance in Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii, as well as percentages of resistance among all Gram-negative bacteria were compared during the study period. RESULTS: Of 668 patients, at least one isolate was obtained from 399 patients. The proportions of patients with infection and with Gram-negative isolates were even across the 5 semesters (p = 0.8). For Klebsiella pneumoniae, the number of strains resistant to carbapenems fell from 94% to 6% (p < 0.001). Significant drops were also observed for Pseudomonas aeruginosa and Acinetobacter baumannii. Percentages of resistance for all Gram-negative isolates fell from 91% to 13% (p < 0.0001). The reduction in antibiotic prescription translated in a considerable reduction of pharmacy costs. Multivariate models confirmed that the hospitalization semester was the most relevant independent predictor of resistance among Gram-negative bacteria. CONCLUSIONS: Our experience provides further evidence that a multi-faceted intervention, aimed to reduce selection and transmission of GNMDROs with efficient microbiological support, may yield remarkable results in a short time interval.
Authors: Giulia Mandelli; Francesca Dore; Martin Langer; Elena Garbero; Laura Alagna; Andrea Bianchin; Rita Ciceri; Antonello Di Paolo; Tommaso Giani; Aimone Giugni; Andrea Gori; Ugo Lefons; Antonio Muscatello; Carlo Olivieri; Angelo Pan; Matteo Pedeferri; Marianna Rossi; Gian Maria Rossolini; Emanuele Russo; Daniela Silengo; Bruno Viaggi; Guido Bertolini; Stefano Finazzi Journal: J Clin Med Date: 2022-07-28 Impact factor: 4.964