Antimicrobial use and resistance among Gram-negative bacilli in an Italian intensive care unit (ICU).
Gram-negative bacilli antimicrobial resistance remains a significant problem for patients in the intensive care unit (ICU). We performed a retrospective analysis of microbiological data and antibiotic consumption over a 4-year period (2000-2003) in an Italian ICU. Pseudomonas aeruginosa and Klebsiella pneumoniae represented approximately 40% of all isolates. The most significant trend in antimicrobial use was an increase in use of 3(rd )generation cephalosporins, imipenem, and ciprofloxacin. A significant trend toward an increase in resistance rates to piperacillin, 3( rd )generation cephalosporins and ciprofloxacin was observed for K. pneumoniae and a positive correlation between resistance and drug-usage was evident for K. pneumoniae and piperacillin, cefotaxime, ceftazidime, cefepime, and ciprofloxacin, but not for piperacillin/tazobactam. No statistically significant correlations were evidenced for P. aeruginosa. Trends in resistances were studied also for Serratia spp and Proteus spp. Isolation rates of extended-spectrum beta-lactamase (ESBL)-producing strains in pathogens studied were high, especially for K. pneumoniae (72%, 160/222) and Proteus spp (41%, 18/43). In conclusion, the study showed high resistance among Gram-negative organisms isolated in the ICU and significant ESBL production. A significant correlation between antibiotic consumption and increasing resistance was evident for K. pneumoniae.
Bassetti
M
M
Department of Infectious Diseases, University of Genoa School of Medicine, San Martino Hospital, Genoa, Italy. matteo.bassetti@hsanmartino.it
Cruciani
M
M
Righi
E
E
Rebesco
B
B
Fasce
R
R
Costa
A
A
Molinari
M P
MP
Mengoli
C
C
Bobbio Pallavicini
F
F
Viscoli
C
C
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D003710:Demography; D024901:Drug Resistance, Multiple, Bacterial; D004363:Drug Utilization; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007362:Intensive Care Units; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents