title: Effects of Carbapenem consumption on the prevalence of Acinetobacter infection in intensive care unit patients.
abstract: BACKGROUND
  The consumption of carbapenems has increased worldwide, together with the increase in resistant gram negative bacilli. Subsequently, the prevalence of carbapenem-resistant Acinetobacter infections has increased rapidly and become a significant problem particularly in intensive care unit patients. The aim of the present study was to evaluate the changes in the prevalence of Acinetobacter infection by restricting the consumption of carbapenems in intensive care unit patients.
  
  
  METHODS
  This study was conducted between May 1, 2011 and February 28, 2013. The amount of carbapenem consumption and the number of patients with multi-drug resistant Acinetobacter baumannii (MDRAB) isolates during the study period were retrospectively obtained from the records of the patients, who were hospitalized in the intensive care unit. The study period was divided into two periods named as: Carbapenem non-restricted period (CNRP) and carbapenem-restricted period (CRP). During CNRP, no restrictions were made on the use of carbapenems. During CRP, the use of carbapenems was not allowed if there was an alternative to carbapenems. Primary Endpoint: MDRAB infection after ICU admission. The definition of nosocomial infections related to Acinetobacter spp. was based on the criteria of the Center for Disease Control (CDC). The correlation between the amount of carbapenem consumption and the number of infections with MDRAB strains between the two periods were evaluated.
  
  
  RESULTS
  During the study period, a total of 1822 patients' (1053 patients in CNRP and 769 patients in CRP) records were evaluated retrospectively. A total of 10.82 defined daily dose (DDD/100 ICU days) of anti-pseudomonal carbapenem were used in CNRP, and this figure decreased to 6.95 DDD/100 ICU days in CRP. In the 8-month CNRP, 42 (3.98%) MDRAB-related nosocomial infections were detected, and 14 (1.82%) infections were detected in CRP (p = 0.012).
  
  
  CONCLUSIONS
  The prevalence of MDRAB strains isolated in the CNRP was 2.24-fold higher than the prevalence in the CRP. The prevalence of Acinetobacter infections can be reduced by taking strict isolation measures as well as by implementing good antibiotics usage policy.
authors.affiliation: Sakarya University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sakarya, Turkey. drogutlu@hotmail.com.
authors.forename: Aziz
authors.initials: A
authors.lastname: Ogutlu
authors.forename: Ertugrul
authors.initials: E
authors.lastname: Guclu
authors.forename: Oguz
authors.initials: O
authors.lastname: Karabay
authors.forename: Aylin Calica
authors.initials: AC
authors.lastname: Utku
authors.forename: Nazan
authors.initials: N
authors.lastname: Tuna
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yahyaoglu
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000302:isolation & purification*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D011307:Drug Prescriptions / Q000592:standards; D024901:Drug Resistance, Multiple, Bacterial; D004363:Drug Utilization / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D015995:Prevalence; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems