Impact of aminoglycoside cycling in six tertiary intensive care units: prospective longitudinal interventional study.
OBJECTIVE
To determine the effect of aminoglycoside cycling in six tertiary intensive care units (ICU) on the rates of sepsis, aminoglycoside resistance patterns, antibiotic consumption, and costs.


METHODS
This was a prospective longitudinal interventional study that measured the effect of change from first-line gentamicin usage (February 2002-February 2003) to amikacin usage (February 2003-February 2004) on the aminoglycoside resistance patterns, number of patients with gram-negative bacteremia, consumption of antibiotics, and the cost of antimicrobial drugs in 6 tertiary care ICUs in Zagreb, Croatia.


RESULTS
The change from first-line gentamicin to amikacin usage led to a decrease in the overall gentamicin resistance of gram-negative bacteria (GNB) from 42% to 26% (P<0.001; z-test of proportions) and netilmicin resistance from 33% to 20% (P<0.001), but amikacin resistance did not change significantly (P=0.462), except for Acinetobacter baumanni (P=0.014). Sepsis rate in ICUs was reduced from 3.6% to 2.2% (P<0.001; chi(2) test), with a decline in the number of nosocomial bloodstream infections from 55/100 patient-days to 26/100 patient-days (P=0.001, chi(2) test). Furthermore, amikacin use led to a 16% decrease in the overall antibiotic consumption and 0.1 euro/patient/d cost reduction.


CONCLUSIONS
Exclusive use of amikacin significantly reduced the resistance of GNB isolates to gentamicin and netilmicin, the number of GNB nosocomial bacteremias, and the cost of total antibiotic usage in ICUs.
Francetić
Igor
I
Department of Internal Medicine, Zagreb University Hospital Center, Kispaticeva 12, 10000 Zagreb, Croatia. ifran@mef.hr
Kalenić
Smilja
S
Huić
Mirjana
M
Mercep
Iveta
I
Makar-Ausperger
Ksenija
K
Likić
Robert
R
Erdeljić
Viktorija
V
Tripković
Vesna
V
Simić
Petra
P
D000583:Amikacin / Q000008:administration & dosage / Q000627:therapeutic use*; D000617:Aminoglycosides / Q000008:administration & dosage / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D017523:Croatia; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects*; D005839:Gentamicins / Q000008:administration & dosage / Q000627:therapeutic use*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D009428:Netilmicin / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D018805:Sepsis / Q000188:drug therapy* / Q000191:economics
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D005839:Gentamicins; D009428:Netilmicin; D000583:Amikacin