The effect of limiting antimicrobial therapy duration on antimicrobial resistance in the critical care setting.
BACKGROUND
Using antimicrobial agents for prolonged periods of time and/or in heavy densities is known to contribute to antimicrobial resistance.


METHODS
A quasiexperimental, before and after study to limit the duration of antimicrobial therapy to 14 days was conducted in a medical-surgical intensive care unit (ICU). An intervention to optimize antimicrobial therapy was performed when antimicrobial agents had been prescribed for more than 14 days. We then compared antimicrobial utilization using the defined daily dose (DDD) per 1000 patient-days, as well as resistance rates in selected organisms in the intervention phase to the previous 10-month period.


RESULTS
In the intervention phase, doctors approved to discontinue the antimicrobial therapy before 14 days in 89.8% (415/462) of the prescribed antibiotics in the ICU. Comparing the 2 time periods, we found a reduction in carbapenems (24.5% decrease), vancomycin (14.3% decrease), and cephalosporins (12.2% decrease) in the intervention phase. Imipenem resistance decreased in Acinetobacter baumannii from 88.5% to 20.0% (P <or= .001) and in Klebsiella pneumoniae from 54.5% to 10.7% (P = .01).


CONCLUSIONS
These results suggest that an intervention to reduce the duration of antimicrobial therapy contributed to more rational use of antimicrobial agents and to the reduction of bacterial resistance in the critical care setting.
Marra
Alexandre R
AR
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil. a.marra@uol.com.br
de Almeida
Silvana Maria
SM
Correa
Luci
L
Silva
Moacyr
M
Martino
Marinês Dalla Valle
MD
Silva
Cláudia Vallone
CV
Cal
Ruy Guilherme Rodrigues
RG
Edmond
Michael B
MB
dos Santos
Oscar Fernando Pavão
OF
D040981:Acinetobacter baumannii / Q000187:drug effects; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007711:Klebsiella pneumoniae / Q000187:drug effects; D013997:Time Factors
D000900:Anti-Bacterial Agents