Change of antibiotic-resistant nosocomial microflora: Results of implementation of the strategy for control of antimicrobial treatment in multi speciality in-patient hospital

Abstract

The unreasonable use of antimicrobial preparations is the one of leading causes of the increase of microbial resistance to antibiotics in in-patient departments. With the aim of containment of the resistance of nosocomial flora in multi-disciplinary in-patient hospital during two years there is used Antimicrobial Stewardship Program (ASP) with the involvement of a team of specialists in appropriate antibiotic therapy, protocols of perioperative antibiotic prophylaxis and empiric antibiotic therapy (EAT), educational programs for personal and measures for the assessment of the efficacy of ASP. The efficacy was evaluated with the use of such indices as the change of the pattern of nosocomial germs, incidence of methicillin-resistant Staphylococcus spp., vancomycin-resistant strains of Enterococcus faecium (VRE), incidence of extended-spectrum beta-lactamases(ESBL)-producing microorganisms, prevalence of carbapenem-resistant gram-negatives, drug resistance index (DRI). Implementation of ASP allowed to properly change the structure of nosocomial germs, to attain the real decline of the incidence of methicillinresistant Staphylococcus aureus (MRSA) from 16,2% (95%CI: 12-20,4) to 10,4% (95%CI: 7-13,8), p<0,05, to shorten the rate of ESBL production among gram-negatives from 61,8% (95%CI: 58,9-64,7) to 57,5% (95%CI: 54,4-60,6), p<0,05, to diminish the resistance of gram-negatives to carbapenems from 28% (95%CI: 26,1-29,9) to 20,6% (95%CI: 18,6-22,6), p<0,001, to achieve the decrease of DRI for main problem gram-negatives.

Keywords

Antimicrobial Resistance / Antimicrobial Stewardship Program (ASP) / Protocol of Empiric Antimicrobial Therapy / Drug Resistance Index (DRI)

References

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