title: The effect of limiting antimicrobial therapy duration on antimicrobial resistance in the critical care setting.
abstract: 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.
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil. a.marra@uol.com.br
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Marra
authors.forename: Silvana Maria
authors.initials: SM
authors.lastname: de Almeida
authors.forename: Luci
authors.initials: L
authors.lastname: Correa
authors.forename: Moacyr
authors.initials: M
authors.lastname: Silva
authors.forename: Marinês Dalla Valle
authors.initials: MD
authors.lastname: Martino
authors.forename: Cláudia Vallone
authors.initials: CV
authors.lastname: Silva
authors.forename: Ruy Guilherme Rodrigues
authors.initials: RG
authors.lastname: Cal
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
authors.forename: Oscar Fernando Pavão
authors.initials: OF
authors.lastname: dos Santos
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents