Implementation of Antibiotic Stewardship in a University Hospital Setting

The article describes activities of an antibiotic center at a university hospital in the Czech Republic and presents the results of antibiotic stewardship program implementation over a period of 10 years. It provides data on the development of resistance of , , and to selected antibiotic agents as well as consumption data for various antibiotic classes. The genetic basis of resistance to beta-lactam antibiotics and its clonal spread were also assessed. The study showed significant correlations between aminoglycoside consumption and resistance of and to gentamicin (r = 0.712, r = 0.869), fluoroquinolone consumption and resistance of to ciprofloxacin (r = 0.896), aminoglycoside consumption and resistance of to amikacin (r = 0.716), as well as carbapenem consumption and resistance of to meropenem (r = 0.855). Genotyping of ESBL- positive isolates of and showed a predominance of CTX-M-type; in AmpC-positive strains, DHA, EBC and CIT enzymes prevailed. Of 19 meropenem-resistant strains of , two were identified as NDM-positive. Clonal spread of these strains was not detected. The results suggest that comprehensive antibiotic stewardship implementation in a healthcare facility may help to maintain the effectiveness of antibiotics against bacterial pathogens. Particularly beneficial is the work of clinical microbiologists who, among other things, approve administration of antibiotics to patients with bacterial infections and directly participate in their antibiotic therapy.