Rational use of antibiotics in the intensive care unit: impact on microbial resistance and costs

To evaluate the impact of an intensive care unit (ICU) antibiotic-use policy on the microbial resistance in nosocomial infections and costs. Comparative study before and after policy implementation. An eleven-bed ICU in a general hospital. All patients admitted for at least 48 h during a 5year period (1994-1998). In 1995, implementation of an antibiotic-use policy. Patients' general characteristics, incidence of nosocomial infections, antibiotic-selective pressure (the number of days of antibiotic treatment for 1,000 days of presence in the ICU), presence and types of multi-resistant micro-organisms and costs linked to antibiotic use were recorded before (1994) and after implementation of the policy (1995-1998). For each year, patients' general characteristics and the incidence of nosocomial infections were the same. Costs linked to antibiotics use showed a progressive reduction (100% for 1994, 81% for 1995, 65% for 1998). Antibiotic-selective pressure diminished (from 940 days of antibiotic use per 1,000 days (1994) to 610 (1998), p