title: Modified guidelines impact on antibiotic use and costs: duration of treatment for pneumonia in a neurosurgical ICU is reduced.
abstract: OBJECTIVE
  To evaluate the impact of an intervention to reduce the duration of antibiotic treatment for pneumonia in a neurosurgical intensive care unit (ICU). The usage of antibiotics and the resultant costs were examined using interrupted time series analysis while resistance and device-associated infection rates are also described.
  
  
  METHODS
  In January 2004, revised guidelines for the use of antibiotics were implemented. As a consequence of this, the duration of antibiotic therapy for nosocomial pneumonia was reduced from 14 to 7 days, while for community-acquired pneumonia the period fell from 10 to 5 days. The effect on the antibiotic use density [AD; expressed as defined daily doses (DDD) per 1000 patient days (pd)] was calculated by segmented regression analysis of interrupted time series for the 24 months prior to (2002 and 2003) and after the intervention (2004 and 2005).
  
  
  RESULTS
  The intervention was associated with a significant decrease in total AD from 949.8 to 626.7 DDD/1000 pd after the intervention. This was mainly due to reduced consumption of second-generation cephalosporins (-100.6 DDD/1000 pd), imidazoles (- 100.3 DDD/1000 pd), carbapenems (-33.3 DDD/1000 pd), penicillins with beta-lactamase inhibitor (-33.5 DDD/1000 pd) and glycopeptides (-30.2 DDD/1000 pd). Glycopeptide reduction might be associated with a significant decrease in the proportion of methicillin-resistant Staphylococcus aureus (8.4% before and 2.9% after the intervention). Similarly, total antibiotic costs/pd (Euro) showed a significant decrease from 13.16 Euro/pd before to 7.31 euro/pd after the intervention. This is a saving of 5.85 Euro/pd. The incidence of patients dying with pneumonia did not change significantly.
  
  
  CONCLUSIONS
  The most conservative estimate of segmented regression analysis over a 48 month period showed that halving the duration of treatment for pneumonia results in a reduction of over 30% in antibiotic consumption and costs. Because respiratory infections are most common in ICU patients, interventions targeting a reduction in the duration of treatment of pneumonia might be extremely worthwhile.
authors: Institute of Environmental Medicine and Hospital Epidemiology, Freiburg University Hospital, Hugstetter Str 55, Freiburg, Germany. elisabeth.meyer@uniklinik-freiburg.de
authors: Elisabeth
authors: E
authors: Meyer
authors: Juergen
authors: J
authors: Buttler
authors: Christian
authors: C
authors: Schneider
authors: Egid
authors: E
authors: Strehl
authors: Barbara
authors: B
authors: Schroeren-Boersch
authors: Petra
authors: P
authors: Gastmeier
authors: Henning
authors: H
authors: Ruden
authors: Josef
authors: J
authors: Zentner
authors: Franz D
authors: FD
authors: Daschner
authors: Frank
authors: F
authors: Schwab
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D003363:Cost Control; D003365:Costs and Cost Analysis; D003422:Critical Care; D003625:Data Collection; D003627:Data Interpretation, Statistical; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000191:economics / Q000706:statistics & numerical data; D017408:Guidelines as Topic; D006801:Humans; D007902:Length of Stay; D019635:Neurosurgical Procedures; D053717:Pneumonia, Ventilator-Associated / Q000191:economics* / Q000382:microbiology / Q000517:prevention & control*; D012044:Regression Analysis
chemical_list: D000900:Anti-Bacterial Agents