[SARI: surveillance of antibiotic use and bacterial resistance in German intensive care units. Correlation between antibiotic use and the emergence of resistance].
Intensive care units (ICUs) are considered to be high-risk areas for the emergence and spread of multiresistant bacterial pathogens. In Germany, there are no representative epidemiological data on antibiotic resistance, on the use of antibiotics in ICUs, or on the correlation between antibiotic use and the emergence of resistance. Project SARI (surveillance of antibiotic use and bacterial resistance in ICUs), which as a part of the epidemiological network Spread of Nosocomial Infections and Resistant Pathogens (SIR) is supported by the German Ministry of Science and Education, started in February 2000 and meanwhile includes data on antibiotic use and resistance rates in 38 medical, surgical, and interdisciplinary ICUs. To date (February 2000-June 2003), a total of 1142 months, 413,065 patient days, and 550,288 defined daily doses (DDDs in accordance with the WHO) have been covered with a mean antibiotic usage density (AD) of 1335 DDDs/1000 patient days and resistance data on 37,612 isolates from ICUs. Ciprofloxacin use and MRSA correlate significantly, as do imipenem use and the rate of imipenemresistant P. aeruginosa. The genodiversity of P. aeruginosa is lower in ICUs with high resistance rates and low use of imipenem than in ICUs with high resistance rates and high use. This is an indirect parameter of transmission of identical strains. The epidemiological data of SARI form a basis for improved antibiotic and infection control management in ICUs (http://www.sari-antibiotika.de).
Meyer
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Institut für Umweltmedizin und Krankenhaushygiene, Universitätsklinikum Freiburg, Freiburg. smeyer@iuk3.ukl.uni-freiburg.de
Jonas
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Schwab
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Gastmeier
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Rüden
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Daschner
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D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects*; D019985:Benchmarking; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D024901:Drug Resistance, Multiple, Bacterial; D004363:Drug Utilization; D014644:Genetic Variation; D005858:Germany; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D007362:Intensive Care Units / Q000592:standards; D008962:Models, Theoretical; D011159:Population Surveillance; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000235:genetics; D011786:Quality Control; D013211:Staphylococcus aureus / Q000187:drug effects; D013997:Time Factors; D014944:World Health Organization
D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D015378:Imipenem