Microbiological surveillance and parenteral antibiotic use: DISCUSSION part 2
While no attempt was made to assess formally the appropriateness of antibiotic prescribing patterns, antibiotic usage did appear to correspond to the clinical indications for which antimicrobial therapy was prescribed, as well as to the bacteria isolated from patients with infection. Active involvement of pharmacy, infectious disease and microbiology personnel may have also affected the appropriateness of antibiotic choice. Finally, the enforcement of strict infection control procedures in the CrCU may have influenced the low incidence of antibiotic resistance observed in the audit.
Although a low level of antimicrobial resistance was demonstrated, our study was limited by the lack of strict criteria and definitions for the diagnosis of specific infections. Furthermore, we assumed that the bacterial isolate recovered from the different sites corresponded to the clinical infections for each infective episode and did not represent colonization. For this reason, we may have overestimated the true infection rates in the CrCU. The present study only looked at the incidence of bacterial resistance with concurrent antibiotic utilization and did not evaluate whether this use accounted for the lower incidence. Finally, the overall prevalence of bacterial resistance in the CrCU was not determined, because we did not collect data on patients admitted to the unit who did not receive parenteral antibiotics. For this same reason, we could not compare resistance rates among those who received antibiotics and those who did not.
The results of this audit demonstrated that antimicrobial use within the CrCU appeared reasonable, and because of the low levels of bacterial resistance, no further recommendations regarding modifications of antimicrobial use were made. A combination of ongoing surveillance for bacterial resistance, monitoring of antibiotic utilization patterns and effective infection control practice may have contributed to this low rate. However, given the increasing reports of the rapid emergence of antimicrobial resistance in ICUs and the variability in resistance patterns in different parts of the hospital, we will continue focused, microbiological surveillance, and study whether appropriate monitoring of antibiotic usage and other factors affect the emergence of bacterial resistance.
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