Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Antimicrobial Resistance & Infection Control
Published in: Antimicrobial Resistance & Infection Control 1/2018

Open Access 01-12-2018 | Research

Antimicrobial consumption in five adult intensive care units: a 33-month surveillance study

Authors: Hanan H. Balkhy, Aiman El-Saed, Ashraf El-Metwally, Yaseen M. Arabi, Sameera M. Aljohany, Muayed Al Zaibag, Salim Baharoon, Adel F. Alothman

Published in: Antimicrobial Resistance & Infection Control | Issue 1/2018

Login to get access

Abstract

Background

Estimating the baseline antimicrobial consumption is extremely important to monitor the impact of antimicrobial stewardship activities that aim to reduce the burden and cost of antimicrobial consumption.

Objectives

To quantify service-specific antimicrobial consumption using different metrics.

Methods

A surveillance study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between October 2012 and June 2015 in five adult intensive care units (ICUs). Consumption data were collected manually on a daily basis by infection control practitioners. Data were presented as defined daily dose (DDD), days of therapy (DOT) per 1000 patient days, and frequency of daily consumption.

Results

A total of 43,970 DDDs and 46,940 DOTs were monitored during 54,116 patient-days. For the most frequently consumed antimicrobials, the consumption of carbapenems, piperacillin/tazobactam, vancomycin, and colistin (respectively) in all ICUs combined were 255.9, 134.3, 98.2, and 13.6 DDDs per 1000 patient-days and 235.7, 145.9, 129.5, and 117.5 DOTs per 1000 patient-days. For the frequency of daily consumption, carbapenems were the most frequently consumed antimicrobial group in medical/surgical, burn, and step-down ICUs while piperacillin/tazobactam was the most frequently consumed antimicrobial in neuro-surgical and cardio-thoracic ICUs.

Conclusion

High consumption of broad-spectrum antimicrobial agents such as meropenem and piperacillin/tazobactam is observed in multiple ICUs in a tertiary care hospital. Meropenem consumption is considerably higher than similar ICUs internationally. Future studies focusing on concurrent monitoring of antimicrobial resistance and identifying patient and physician characteristics associated with specific prescription patterns may help in improving judicious antimicrobial consumption.
Literature
1.
2.
Lode H. Safety and tolerability of commonly prescribed oral antibiotics for the treatment of respiratory tract infections. Am J Med. 2010;123(4 Suppl):S26–38.CrossRefPubMed
3.
Chang CY, Schiano TD. Review article: drug hepatotoxicity. Aliment Pharmacol Ther. 2007;25(10):1135–51.CrossRefPubMed
4.
Cotteret C, Vallieres E, Roy H, Ovetchkine P, Longtin J, Bussieres JF. Antibiotic consumption and bacterial sensitivity in a teaching hospital: a 5-year study. Arch Pediatr. 2016;23(10):1040–9.CrossRefPubMed
5.
Schechner V, Temkin E, Harbarth S, Carmeli Y, Schwaber MJ. Epidemiological interpretation of studies examining the effect of antibiotic usage on resistance. Clin Microbiol Rev. 2013;26(2):289–307.CrossRefPubMedPubMedCentral
6.
Lopez-Lozano JM, Monnet DL, Yague A, Burgos A, Gonzalo N, Campillos P, Saez M. Modelling and forecasting antimicrobial resistance and its dynamic relationship to antimicrobial use: a time series analysis. Int J Antimicrob Agents. 2000;14(1):21–31.CrossRefPubMed
7.
Goossens H, Ferech M, Vander Stichele R, Elseviers M. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;365(9459):579–87.CrossRefPubMed
8.
9.
10.
Balkhy HH, Assiri AM, Mousa HA, Al-Abri SS, Al-Katheeri H, Alansari H, Abdulrazzaq NM, Aidara-Kane A, Pittet D. The strategic plan for combating antimicrobial resistance in gulf cooperation council states. J Infec Public Health. 2016;9(4):375–85.CrossRef
11.
Huttner B, Goossens H, Verheij T, Harbarth S. Characteristics and outcomes of public campaigns aimed at improving the use of antibiotics in outpatients in high-income countries. Lancet Infect Dis. 2010;10(1):17–31.CrossRefPubMed
12.
Bitterman R, Raz-Pasteur A, Azzam ZS, Karban A, Levy Y, Hayek T, Braun E, Oren I, Bar-Lavi Y, Kassis I, et al. Reduction of antibiotic consumption in Rambam health care campus - the role of an antibiotic stewardship program. Harefuah. 2017;156(9):573–7.PubMed
13.
Johnson AP, Muller-Pebody B, Budd E, Ashiru-Oredope D, Ladenheim D, Hain D, Hope R, Bhattacharya A, Elgohari S, Guy R, et al. Improving feedback of surveillance data on antimicrobial consumption, resistance and stewardship in England: putting the data at your fingertips. J Antimicrob Chemother. 2017;72(4):953–6.PubMed
14.
15.
Momattin H, Al-Ali AY, Mohammed K, Al-Tawfiq JA. Benchmarking of antibiotic usage: an adjustment to reflect antibiotic stewardship program outcome in a hospital in Saudi Arabia. J Infect Public Health. 2017.
16.
World Health Organization. WHO collaborating Centre for Drug Statistics Methodology, guidelines for ATC classification and DDD assignment 2011. Oslo. 2010:2010.
17.
National Healthcare Safety Network (NHSN). Antimicrobial use and resistance (AUR) option. Patient Saf Component Manual. June 2011:2011.
18.
Collado R, Losa JE, Alvaro EA, Toro P, Moreno L, Perez M. Measurement of antimicrobial consumption using DDD per 100 bed-days versus DDD per 100 discharges after the implementation of an antimicrobial stewardship program. Rev Esp Quimioter. 2015;28(6):317–21.PubMed
19.
Fortin E, Quach C, Fontela PS, Buckeridge DL, Platt RW. A simulation study to assess indicators of antimicrobial use as predictors of resistance: does it matter which Indicator is used? PLoS One. 2015;10(12):e0145761.CrossRefPubMedPubMedCentral
20.
Berrington A. Antimicrobial prescribing in hospitals: be careful what you measure. J Antimicrob Chemother. 2010;65(1):163–8.CrossRefPubMed
21.
Polk RE, Fox C, Mahoney A, Letcavage J, MacDougall C: Measurement of adult antibacterial drug use in 130 US hospitals: comparison of defined daily dose and days of therapy. Clin Infec Dis 2007; 44(5):664–670.
22.
Marquet K, Liesenborgs A, Bergs J, Vleugels A, Claes N. Incidence and outcome of inappropriate in-hospital empiric antibiotics for severe infection: a systematic review and meta-analysis. Crit Care. 2015;19(1):63.CrossRefPubMedPubMedCentral
23.
Youssif E, Aseeri M, Khoshhal S. Retrospective evaluation of piperacillin-tazobactam, imipenem-cilastatin and meropenem used on surgical floors at a tertiary care hospital in Saudi Arabia. J Infect Public Health. 2017.
24.
Balkhy HH, El-Saed A, Al Johani SM, Francis C, Al-Qahtani AA, Al-Ahdal MN, Altayeb HT, Arabi Y, Alothman A, Sallah M. The epidemiology of the first described carbapenem-resistant Klebsiella pneumoniae outbreak in a tertiary care hospital in Saudi Arabia: how far do we go? Eur J Clin Microbiol Infec Dis. 2012;31(8):1901–9.CrossRef
25.
Balkhy HH, El-Saed A, Maghraby R, Al-Dorzi HM, Khan R, Rishu AH, Arabi YM. Drug-resistant ventilator associated pneumonia in a tertiary care hospital in Saudi Arabia. Ann Thoracic Med. 2014;9(2):104–11.CrossRef
26.
Alotaibi FE, Bukhari EE, Al-Mohizea MM, Hafiz T, Essa EB, AlTokhais YI. Emergence of carbapenem-resistant Enterobacteriaceae isolated from patients in a university hospital in Saudi Arabia. Epidemiology, clinical profiles and outcomes. J Infect Public Health. 2017;10(5):667–73.CrossRefPubMedPubMedCentral
27.
Zowawi HM, Sartor AL, Balkhy HH, Walsh TR, Al Johani SM, AlJindan RY, Alfaresi M, Ibrahim E, Al-Jardani A, Al-Abri S, et al. Molecular characterization of carbapenemase-producing Escherichia coli and Klebsiella pneumoniae in the countries of the Gulf cooperation council: dominance of OXA-48 and NDM producers. Antimicrob Agents Chemother. 2014;58(6):3085–90.CrossRefPubMedPubMedCentral
28.
Garbati MA, Sakkijha H, Abushaheen A. Infections due to Carbapenem resistant Enterobacteriaceae among Saudi Arabian hospitalized patients: a matched case-control study. Biomed Res Int. 2016;2016:3961684.CrossRefPubMedPubMedCentral
29.
Dumartin C, L'Heriteau F, Pefau M, Bertrand X, Jarno P, Boussat S, Angora P, Lacave L, Saby K, Savey A, et al. Antibiotic use in 530 French hospitals: results from a surveillance network at hospital and ward levels in 2007. J Antimicrob Chemother. 2010;65(9):2028–36.CrossRefPubMed
30.
National Nosocomial Infections Surveillance. (NNIS): NNIS system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004;32(8):470–85.CrossRef
31.
Meyer E, Schwab F, Gastmeier P, Rueden H, Daschner FD. Surveillance of antimicrobial use and antimicrobial resistance in German intensive care units (SARI): a summary of the data from 2001 through 2004. Infection. 2006;34(6):303–9.CrossRefPubMedPubMedCentral
32.
Rosenthal VD, Maki DG, Mehta A, Álvarez-Moreno C, Leblebicioglu H, Higuera F, Cuellar LE, Madani N, Mitrev Z, Dueñas L, et al. International nosocomial infection control consortium report, data summary for 2002-2007, issued January 2008. Am J Infect Control. 2008;36(9):627–37.CrossRefPubMed
33.
Walther SM, Erlandsson M, Burman LG, Cars O, Gill H, Hoffman M, Isaksson B, Kahlmeter G, Lindgren S, Nilsson L, et al. Antibiotic prescription practices, consumption and bacterial resistance in a cross section of Swedish intensive care units. Acta Anaesthesiol Scand. 2002;46(9):1075–81.CrossRefPubMed
34.
Vaccheri A, Silvani MC, Bersaglia L, Motola D, Strahinja P, Vargiu A, Poluzzi E, Montanaro N. A 3 year survey on the use of antibacterial agents in five Italian hospitals. J Antimicrob Chemother. 2008;61(4):953–8.CrossRefPubMed
35.
Dulhunty JM, Paterson D, Webb SA, Lipman J. Antimicrobial utilisation in 37 Australian and New Zealand intensive care units. Anaesth Intensive Care. 2011;39(2):231–7.CrossRefPubMed
36.
Polk RE, Hohmann SF, Medvedev S, Ibrahim O. Benchmarking risk-adjusted adult antibacterial drug use in 70 US academic medical center hospitals. Clin Infec Dis. 2011;53(11):1100–10.CrossRef
37.
Dalton BR, MacTavish SJ, Bresee LC, Rajapakse N, Vanderkooi O, Vayalumkal J, Conly J. Antimicrobial use over a four-year period using days of therapy measurement at a Canadian pediatric acute care hospital. Can J Infect Dis Med Microbiol. 2015;26(5):253–8.CrossRefPubMedPubMedCentral
38.
Cantey JB, Wozniak PS, Sanchez PJ. Prospective surveillance of antibiotic use in the neonatal intensive care unit: results from the SCOUT study. Pediatr Infect Dis J. 2015;34(3):267–72.CrossRefPubMed
39.
Candeloro CL, Kelly LM, Bohdanowicz E, Martin CM, Bombassaro AM. Antimicrobial use in a critical care unit: a prospective observational study. Int J Pharm Pract. 2012;20(3):164–71.CrossRefPubMed
40.
Kaki R, Elligsen M, Walker S, Simor A, Palmay L, Daneman N. Impact of antimicrobial stewardship in critical care: a systematic review. J Antimicrob Chemother. 2011;66(6):1223–30.CrossRefPubMed
Metadata
Title
Antimicrobial consumption in five adult intensive care units: a 33-month surveillance study
Authors
Hanan H. Balkhy
Aiman El-Saed
Ashraf El-Metwally
Yaseen M. Arabi
Sameera M. Aljohany
Muayed Al Zaibag
Salim Baharoon
Adel F. Alothman
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Antimicrobial Resistance & Infection Control / Issue 1/2018
Electronic ISSN: 2047-2994
DOI
https://doi.org/10.1186/s13756-018-0451-9

Other articles of this Issue 1/2018

Antimicrobial Resistance & Infection Control 1/2018 Go to the issue

Research

Attitude and perception of medical interns about antimicrobial resistance: a multi center cross-sectional study in Ethiopia

Research

Prospective surveillance of healthcare-associated infections and patterns of antimicrobial resistance of pathogens in an Italian intensive care unit

Research

Continuous increase of vancomycin resistance in enterococci causing nosocomial infections in Germany − 10 years of surveillance

Research

In vitro and in vivo bactericidal activity of ceftazidime-avibactam against Carbapenemase–producing Klebsiella pneumoniae

Research

Neisseria Gonorrhoae and their antimicrobial susceptibility patterns among symptomatic patients from Gondar town, north West Ethiopia

Research

The importance of adjusting for enterococcus species when assessing the burden of vancomycin resistance: a cohort study including over 1000 cases of enterococcal bloodstream infections
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits