Antibiotic consumption after implementation of a procalcitonin-guided antimicrobial stewardship programme in surgical patients admitted to an intensive care unit: a retrospective before-and-after analysis
Purpose To analyse antibiotic use density (AD)—World Health Organization defined daily doses/1,000 patient-days—before and after implementation of a local antimicrobial stewardship programme (ASP) in conjunction with a procalcitonin (PCT)-guided protocol in a surgical intensive care unit (ICU). Meth...
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| Veröffentlicht in: | Infection 2015-08, Vol.43 (4), p.405-412 |
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| creator | Hohn, A. Heising, B. Hertel, S. Baumgarten, G. Hochreiter, M. Schroeder, S. |
| description | Purpose
To analyse antibiotic use density (AD)—World Health Organization defined daily doses/1,000 patient-days—before and after implementation of a local antimicrobial stewardship programme (ASP) in conjunction with a procalcitonin (PCT)-guided protocol in a surgical intensive care unit (ICU).
Methods
In this retrospective observational study, data on 2,422 ICU patients between 2010 and 2012 were analysed. In 2011, an ASP in conjunction with a PCT protocol had been introduced into clinical practice. In a multivariate analysis, hospital mortality, length of stay (LOS) in hospital and ICU LOS were adjusted for effects from effective cost weight, gender, and age. AD and changes in the use of antibiotic classes were analysed.
Results
AD decreased from 1,005.0 in 2010 to 791.9 in 2012 which is a total reduction of 21.2 %. Consumption of aminoglycosides, cephalosporins and quinolones showed a marked reduction, whereas the use of penicillins did not change significantly. The multivariate models revealed no relevant changes in mortality rate, ICU LOS and hospital LOS.
Conclusions
Implementation of an ASP in conjunction with a PCT protocol in 2011 was associated with a marked decrease in total AD and led to a significant change in the spectrum of antibiotics. Clinical outcomes appeared to remain unchanged over the study period. |
| doi_str_mv | 10.1007/s15010-014-0718-x |
| format | Article |
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To analyse antibiotic use density (AD)—World Health Organization defined daily doses/1,000 patient-days—before and after implementation of a local antimicrobial stewardship programme (ASP) in conjunction with a procalcitonin (PCT)-guided protocol in a surgical intensive care unit (ICU).
Methods
In this retrospective observational study, data on 2,422 ICU patients between 2010 and 2012 were analysed. In 2011, an ASP in conjunction with a PCT protocol had been introduced into clinical practice. In a multivariate analysis, hospital mortality, length of stay (LOS) in hospital and ICU LOS were adjusted for effects from effective cost weight, gender, and age. AD and changes in the use of antibiotic classes were analysed.
Results
AD decreased from 1,005.0 in 2010 to 791.9 in 2012 which is a total reduction of 21.2 %. Consumption of aminoglycosides, cephalosporins and quinolones showed a marked reduction, whereas the use of penicillins did not change significantly. The multivariate models revealed no relevant changes in mortality rate, ICU LOS and hospital LOS.
Conclusions
Implementation of an ASP in conjunction with a PCT protocol in 2011 was associated with a marked decrease in total AD and led to a significant change in the spectrum of antibiotics. Clinical outcomes appeared to remain unchanged over the study period.</description><identifier>ISSN: 0300-8126</identifier><identifier>EISSN: 1439-0973</identifier><identifier>DOI: 10.1007/s15010-014-0718-x</identifier><identifier>PMID: 25588968</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Anti-Bacterial Agents - economics ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Bacterial Infections - drug therapy ; Bacterial Infections - mortality ; Bacterial Infections - prevention & control ; Calcitonin - blood ; Calcitonin Gene-Related Peptide ; Critical Care ; Drug Costs ; Drug Utilization - statistics & numerical data ; Family Medicine ; General Practice ; Hospital Mortality ; Humans ; Infectious Diseases ; Intensive Care Units ; Internal Medicine ; Length of Stay - statistics & numerical data ; Medicine ; Medicine & Public Health ; Mortality ; Multivariate Analysis ; Observational studies ; Original Paper ; Protein Precursors - blood ; Retrospective Studies</subject><ispartof>Infection, 2015-08, Vol.43 (4), p.405-412</ispartof><rights>Springer-Verlag Berlin Heidelberg 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-28d652a4260c454b2541a74993df57919d88ef4afc58af030dc8dc666523018a3</citedby><cites>FETCH-LOGICAL-c475t-28d652a4260c454b2541a74993df57919d88ef4afc58af030dc8dc666523018a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s15010-014-0718-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s15010-014-0718-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25588968$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hohn, A.</creatorcontrib><creatorcontrib>Heising, B.</creatorcontrib><creatorcontrib>Hertel, S.</creatorcontrib><creatorcontrib>Baumgarten, G.</creatorcontrib><creatorcontrib>Hochreiter, M.</creatorcontrib><creatorcontrib>Schroeder, S.</creatorcontrib><title>Antibiotic consumption after implementation of a procalcitonin-guided antimicrobial stewardship programme in surgical patients admitted to an intensive care unit: a retrospective before-and-after analysis</title><title>Infection</title><addtitle>Infection</addtitle><addtitle>Infection</addtitle><description>Purpose
To analyse antibiotic use density (AD)—World Health Organization defined daily doses/1,000 patient-days—before and after implementation of a local antimicrobial stewardship programme (ASP) in conjunction with a procalcitonin (PCT)-guided protocol in a surgical intensive care unit (ICU).
Methods
In this retrospective observational study, data on 2,422 ICU patients between 2010 and 2012 were analysed. In 2011, an ASP in conjunction with a PCT protocol had been introduced into clinical practice. In a multivariate analysis, hospital mortality, length of stay (LOS) in hospital and ICU LOS were adjusted for effects from effective cost weight, gender, and age. AD and changes in the use of antibiotic classes were analysed.
Results
AD decreased from 1,005.0 in 2010 to 791.9 in 2012 which is a total reduction of 21.2 %. Consumption of aminoglycosides, cephalosporins and quinolones showed a marked reduction, whereas the use of penicillins did not change significantly. The multivariate models revealed no relevant changes in mortality rate, ICU LOS and hospital LOS.
Conclusions
Implementation of an ASP in conjunction with a PCT protocol in 2011 was associated with a marked decrease in total AD and led to a significant change in the spectrum of antibiotics. Clinical outcomes appeared to remain unchanged over the study period.</description><subject>Anti-Bacterial Agents - economics</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Bacterial Infections - drug therapy</subject><subject>Bacterial Infections - mortality</subject><subject>Bacterial Infections - prevention & control</subject><subject>Calcitonin - blood</subject><subject>Calcitonin Gene-Related Peptide</subject><subject>Critical Care</subject><subject>Drug Costs</subject><subject>Drug Utilization - statistics & numerical data</subject><subject>Family Medicine</subject><subject>General Practice</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Infectious Diseases</subject><subject>Intensive Care Units</subject><subject>Internal Medicine</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Observational studies</subject><subject>Original Paper</subject><subject>Protein Precursors - blood</subject><subject>Retrospective Studies</subject><issn>0300-8126</issn><issn>1439-0973</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkk-L1TAQwIso7rr6AbxIwIuX6KRN29TbsvgPFrzoucxLps8sbVKTVHe_ox_KeftWEUHwFMj85jeZyVTVUwUvFUD_KqsWFEhQWkKvjLy-V50q3QwShr65X51CAyCNqruT6lHOVwDQDrp_WJ3UbWvM0JnT6sd5KH7nY_FW2BjytqzFxyBwKpSEX9aZFgoFby_jJFCsKVqcrS8x-CD3m3fkBLJl8TbFncdZ5ELfMbn8xa8HfJ9wWUj4IPKW9p6zxcpC1maBbvGlsKFEljBTKGT_jYTFRGILvrzmmolKinklWw6hHU0xkcTg5PGZGHC-yT4_rh5MOGd6cneeVZ_fvvl08V5efnz34eL8Ulrdt0XWxnVtjbruwOpW7-pWK-z1MDRuavtBDc4YmjROtjU48RCdNc52HSc1oAw2Z9WLo5eb-7pRLuPis6V5xkBxy6PqFeuA_-U_UFBN0xvdMfr8L_Qqbolbu6Wg7k2ngSl1pHjYOSeaxjX5BdPNqGA8bMV43IqRq4-HrRivOefZnXnbLeR-Z_xaAwbqI5A5FPaU_ij9T-tPjK3H3A</recordid><startdate>20150801</startdate><enddate>20150801</enddate><creator>Hohn, A.</creator><creator>Heising, B.</creator><creator>Hertel, S.</creator><creator>Baumgarten, G.</creator><creator>Hochreiter, M.</creator><creator>Schroeder, S.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>RC3</scope><scope>7X8</scope><scope>7T2</scope><scope>7T7</scope><scope>7U2</scope></search><sort><creationdate>20150801</creationdate><title>Antibiotic consumption after implementation of a procalcitonin-guided antimicrobial stewardship programme in surgical patients admitted to an intensive care unit: a retrospective before-and-after analysis</title><author>Hohn, A. ; Heising, B. ; Hertel, S. ; Baumgarten, G. ; Hochreiter, M. ; Schroeder, S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-28d652a4260c454b2541a74993df57919d88ef4afc58af030dc8dc666523018a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Anti-Bacterial Agents - economics</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotics</topic><topic>Bacterial Infections - drug therapy</topic><topic>Bacterial Infections - mortality</topic><topic>Bacterial Infections - prevention & control</topic><topic>Calcitonin - blood</topic><topic>Calcitonin Gene-Related Peptide</topic><topic>Critical Care</topic><topic>Drug Costs</topic><topic>Drug Utilization - statistics & numerical data</topic><topic>Family Medicine</topic><topic>General Practice</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Infectious Diseases</topic><topic>Intensive Care Units</topic><topic>Internal Medicine</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Multivariate Analysis</topic><topic>Observational studies</topic><topic>Original Paper</topic><topic>Protein Precursors - blood</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hohn, A.</creatorcontrib><creatorcontrib>Heising, B.</creatorcontrib><creatorcontrib>Hertel, S.</creatorcontrib><creatorcontrib>Baumgarten, G.</creatorcontrib><creatorcontrib>Hochreiter, M.</creatorcontrib><creatorcontrib>Schroeder, S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Safety Science and Risk</collection><jtitle>Infection</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hohn, A.</au><au>Heising, B.</au><au>Hertel, S.</au><au>Baumgarten, G.</au><au>Hochreiter, M.</au><au>Schroeder, S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antibiotic consumption after implementation of a procalcitonin-guided antimicrobial stewardship programme in surgical patients admitted to an intensive care unit: a retrospective before-and-after analysis</atitle><jtitle>Infection</jtitle><stitle>Infection</stitle><addtitle>Infection</addtitle><date>2015-08-01</date><risdate>2015</risdate><volume>43</volume><issue>4</issue><spage>405</spage><epage>412</epage><pages>405-412</pages><issn>0300-8126</issn><eissn>1439-0973</eissn><abstract>Purpose
To analyse antibiotic use density (AD)—World Health Organization defined daily doses/1,000 patient-days—before and after implementation of a local antimicrobial stewardship programme (ASP) in conjunction with a procalcitonin (PCT)-guided protocol in a surgical intensive care unit (ICU).
Methods
In this retrospective observational study, data on 2,422 ICU patients between 2010 and 2012 were analysed. In 2011, an ASP in conjunction with a PCT protocol had been introduced into clinical practice. In a multivariate analysis, hospital mortality, length of stay (LOS) in hospital and ICU LOS were adjusted for effects from effective cost weight, gender, and age. AD and changes in the use of antibiotic classes were analysed.
Results
AD decreased from 1,005.0 in 2010 to 791.9 in 2012 which is a total reduction of 21.2 %. Consumption of aminoglycosides, cephalosporins and quinolones showed a marked reduction, whereas the use of penicillins did not change significantly. The multivariate models revealed no relevant changes in mortality rate, ICU LOS and hospital LOS.
Conclusions
Implementation of an ASP in conjunction with a PCT protocol in 2011 was associated with a marked decrease in total AD and led to a significant change in the spectrum of antibiotics. Clinical outcomes appeared to remain unchanged over the study period.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>25588968</pmid><doi>10.1007/s15010-014-0718-x</doi><tpages>8</tpages></addata></record> |
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| ispartof | Infection, 2015-08, Vol.43 (4), p.405-412 |
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| language | eng |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Anti-Bacterial Agents - economics Anti-Bacterial Agents - therapeutic use Antibiotics Bacterial Infections - drug therapy Bacterial Infections - mortality Bacterial Infections - prevention & control Calcitonin - blood Calcitonin Gene-Related Peptide Critical Care Drug Costs Drug Utilization - statistics & numerical data Family Medicine General Practice Hospital Mortality Humans Infectious Diseases Intensive Care Units Internal Medicine Length of Stay - statistics & numerical data Medicine Medicine & Public Health Mortality Multivariate Analysis Observational studies Original Paper Protein Precursors - blood Retrospective Studies |
| title | Antibiotic consumption after implementation of a procalcitonin-guided antimicrobial stewardship programme in surgical patients admitted to an intensive care unit: a retrospective before-and-after analysis |
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