title: Rational use of antibiotics in the intensive care unit: impact on microbial resistance and costs.
abstract: OBJECTIVE
  To evaluate the impact of an intensive care unit (ICU) antibiotic-use policy on the microbial resistance in nosocomial infections and costs.
  
  
  METHODS
  Comparative study before and after policy implementation.
  
  
  METHODS
  An eleven-bed ICU in a general hospital.
  
  
  METHODS
  All patients admitted for at least 48 h during a 5year period (1994-1998).
  
  
  METHODS
  In 1995, implementation of an antibiotic-use policy.
  
  
  RESULTS
  Patients' general characteristics, incidence of nosocomial infections, antibiotic-selective pressure (the number of days of antibiotic treatment for 1,000 days of presence in the ICU), presence and types of multi-resistant micro-organisms and costs linked to antibiotic use were recorded before (1994) and after implementation of the policy (1995-1998). For each year, patients' general characteristics and the incidence of nosocomial infections were the same. Costs linked to antibiotics use showed a progressive reduction (100% for 1994, 81% for 1995, 65% for 1998). Antibiotic-selective pressure diminished (from 940 days of antibiotic use per 1,000 days (1994) to 610 (1998), p<10(-5)). A statistically significant reduction in nosocomial infections due to antimicrobial resistant micro-organisms was observed (from 37% (1994) to 15% (1998) of nosocomial infections, p<10(-5)) after 3 years of implementation of the policy, essentially due to a reduction in methicillin-resistant Staphylococcus aureus and ceftriaxone-resistant Enterobacteriaceae. Nosocomial infections due to ceftazidime-resistant Pseudomonas species or extended-spectrum ss-lactamase Enterobacteriaceae showed no reduction.
  
  
  CONCLUSIONS
  Antibiotic-use policy allowed a reduction in antibiotic-selective pressure, costs linked to antibiotics and selective reduction of nosocomial infections due to antimicrobial resistant micro-organisms.
authors.affiliation: Intensive Care Unit, Font Pré Hospital, 1208 Avenue du Colonel Picot, 83100 Toulon, France. alain.geissler@wanadoo.fr
authors.forename: Alain
authors.initials: A
authors.lastname: Geissler
authors.forename: Patrick
authors.initials: P
authors.lastname: Gerbeaux
authors.forename: Isabelle
authors.initials: I
authors.lastname: Granier
authors.forename: Philippe
authors.initials: P
authors.lastname: Blanc
authors.forename: Karine
authors.initials: K
authors.lastname: Facon
authors.forename: Jacques
authors.initials: J
authors.lastname: Durand-Gasselin
mesh_terms: D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D003428:Cross Infection / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D024881:Drug Resistance, Bacterial; D005602:France / Q000453:epidemiology; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000191:economics; D008875:Middle Aged; D016134:Organizational Policy
chemical_list: D000900:Anti-Bacterial Agents