Microbiological surveillance and parenteral antibiotic use in a critical care unit.
OBJECTIVE
To evaluate parenteral antibiotic utilization and bacterial resistance patterns in a critical care unit (CrCU).


METHODS
Descriptive, prospective audit of infection site, culture and antimicrobial susceptibility test results, parenteral antibiotic usage and duration, total antibiotic acquisition costs, and length of stay.


METHODS
A 17-bed medical-surgical CrCU in a tertiary care teaching hospital in Metropolitan Toronto.


METHODS
Two hundred and fifty-eight patients admitted to the CrCU between May 1995 and April 1996 who received antimicrobial therapy.


RESULTS
The most frequently prescribed antibiotics were cefazolin (47%, 1098 g), gentamicin (33%,141 g) and ceftriaxone (20%, 255 g). The most common indications for antimicrobial therapy included surgical prophylaxis (34%) and pneumonia (35%). The following organisms were isolated from patients treated with antibiotics: Staphylococcus aureus (26%), Pseudomonas aeruginosa (13%), enterococci (12%), Haemophilus influenzae (11%), Escherichia coli (11%), Enterobacter cloacae (8%) and other Gram-negative bacilli (19%). Only 9% of Gram-negative bacilli were resistant to aminoglycosides, 3% were resistant to ciprofloxacin and no extended-spectrum beta-lactamases or imipenem-resistance were detected. No vancomycin-resistant enterococci and only two methicillin-resistant Staphylococcus aureus isolates were identified.


CONCLUSIONS
Antibiotic use during the audit appeared appropriate for the specific clinical indications. Low levels of bacterial resistance were detected during the audit.
Yamashita
S K
SK
Department of Pharmacy, Department of Medicine, Sunnybrook and Women's College Health Sciences Centre, and University of Toronto, Toronto, Ontario. sharon.yamashita@swchsc.on.ca
Louie
M
M
Simor
A E
AE
Rachlis
A
A