caa a22 4500 606155856 CHVBK 20210128100605.0 cr unu---uuuuu 210128e20150901xx s 000 0 eng 10.1007/s10096-015-2429-3 doi (NATIONALLICENCE)springer-10.1007/s10096-015-2429-3 A three-point time series study of antibiotic usage on an intensive care unit, following an antibiotic stewardship programme, after an outbreak of multi-resistant Acinetobacter baumannii [Elektronische Daten] [S. Singh, Y. Zhang, S. Chalkley, K. Ananthan, E. Demertzi, M. Beach, M. Cohen, V. Grover, C. Chung, J. Tatlock, N. Soni, B. Azadian] Antibiotic use in intensive care units (ICUs) can promote antimicrobial resistance. Outbreaks of multi-resistant bacteria significantly affect patient outcomes and delivery of care. Antibiotic stewardship programmes (ASPs), combining root-cause analyses and multi-faceted prevention strategies, are necessary, often at significant cost and time. Which elements of such strategies have the largest impact on antibiotic usage following an outbreak is unclear. The aim of this study was to investigate how antibiotic usage in a university hospital ICU changed with a non-protocolised ASP following a disruptive outbreak of multi-resistant Acinetobacter baumannii (MRAB). This was a three time-period observational cohort study. The primary endpoint was the change in overall antibiotic usage (daily defined dose, DDD, antibiotic-days, antibiotic-courses) for consecutive ICU patients staying >48h, over three 6-month study time periods pre-MRAB (2008, n = 84) and post-MRAB (2010, n = 88; 2012, n = 122). Secondary endpoints were changes in antibiotic usage and patient demographics, in predefined admission categories (Medical Emergency, ME; Surgical Elective, SEL; and Surgical Emergency, SE). The mean age (54.6 ± 17.7, 58.1 ± 17.9, 62.8 ± 19.1 years*) and severity of illness (APACHE 14.8 ± 8.0, 16.7 ± 6.8, 18.3 ± 6.1*) increased, particularly medical admissions. There was a sustained reduction in DDD antibiotic usage [1895.1 (2008), 1224.2 (2010), 1236.6 (2012) per 1000 patient-days] but no overall change in antibiotic-days or antibiotic-courses. Antibiotic usage (antibiotic-days) fell significantly in surgical emergency admissions [20.2 ± 32.1, 4.6 ± 7.4*, 5.9 ± 7.3]. There was a sustained drop in beta-lactam, quinolone, glycopeptide and macrolide usage. Following an MRAB outbreak, and subsequent operational changes including enhanced ASPs (non-protocolised), there was a sustained overall fall in antibiotic usage in spite of an increase in disease severity over 5years. Springer-Verlag Berlin Heidelberg, 2015 Singh S. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut Zhang Y. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut Chalkley S. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut Ananthan K. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut Demertzi E. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut Beach M. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut Cohen M. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut Grover V. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut Chung C. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut Tatlock J. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut Soni N. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut Azadian B. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut European Journal of Clinical Microbiology & Infectious Diseases Springer Berlin Heidelberg 34/9(2015-09-01), 1893-1900 0934-9723 34:9<1893 2015 34 10096 https://doi.org/10.1007/s10096-015-2429-3 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10096-015-2429-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Singh S. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut NATIONALLICENCE 700 1- Zhang Y. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut NATIONALLICENCE 700 1- Chalkley S. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut NATIONALLICENCE 700 1- Ananthan K. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut NATIONALLICENCE 700 1- Demertzi E. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut NATIONALLICENCE 700 1- Beach M. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut NATIONALLICENCE 700 1- Cohen M. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut NATIONALLICENCE 700 1- Grover V. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut NATIONALLICENCE 700 1- Chung C. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut NATIONALLICENCE 700 1- Tatlock J. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut NATIONALLICENCE 700 1- Soni N. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut NATIONALLICENCE 700 1- Azadian B. Intensive Care Unit, Chelsea and Westminster Hospital, Magill Department of Anaesthesia, Intensive Care and Pain Medicine, Imperial College, 369 Fulham Road, SW10 9NH, London, UK aut NATIONALLICENCE 773 0- European Journal of Clinical Microbiology & Infectious Diseases Springer Berlin Heidelberg 34/9(2015-09-01), 1893-1900 0934-9723 34:9<1893 2015 34 10096