Microbiological surveillance and parenteral antibiotic use
Microbiological surveillance and parenteral antibiotic use in a critical care unit
The emergence of antimicrobial resistance over the past several decades has challenged the management of infections in hospitalized patients, and has led to increased morbidity, higher health care costs and prolonged hospitalizations. Hospitals are now frequently encountering outbreaks of resistant organisms such as vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). Patients admitted to intensive care units, in particular, often become colonized with resistant organisms and may serve as the focus for hospital-wide bacterial resistance. The high prevalence of resistance in intensive care units (ICUs) has been attributed to the severity of illness of the patients, prolonged hospital stays, and the widespread use of invasive devices and broad spectrum antibiotics.
It has been suggested that surveillance of bacterial resistance patterns is a useful technique to control the emergence of resistant organisms. Early detection of resistant organisms allows for specific measures to be implemented to prevent the widespread transmission of bacterial resistance. Furthermore, as the choice of antimicrobial therapy for noso- comial infections is often governed by local resistance patterns, surveillance of bacterial susceptibility can aid in making decisions regarding empirical antimicrobial therapy at each institution. The collection of information on antibiotic usage is also essential because selective pressure exerted by the use of certain antibiotics may impact on resistance patterns. The increased use of third-generation cephalo- sporins in the ICUs, for example, may lead to the selection of highly resistant Gram-negative bacilli. Surveillance for both bacterial resistance and antimicrobial usage can therefore be used to improve antibiotic prescribing, as well as to detect early changes in resistance patterns that would require intervention.
We conducted a prospective one-year survey for the purpose of surveillance of antibiotic use and microbial resistance in our critical care unit (CrCU).
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