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Linking antimicrobial prescribing to antimicrobial resistance in the ICU: before and after an antimicrobial stewardship program.
- Source :
-
Epidemics [Epidemics] 2012 Dec; Vol. 4 (4), pp. 203-10. Date of Electronic Publication: 2012 Dec 17. - Publication Year :
- 2012
-
Abstract
- Antimicrobials are an effective treatment for many types of infections, but their overuse promotes the spread of resistant microorganisms that defy conventional treatments and complicate patient care. In 2009, an antimicrobial stewardship program was implemented at Mount Sinai Hospital (MSH, Toronto, Canada). Components of this program were to alter the fraction of patients prescribed antimicrobials, to shorten the average duration of treatment, and to alter the types of antimicrobials prescribed. These components were incorporated into a mathematical model that was compared to data reporting the number of patients colonized with Pseudomonas aeruginosa and the number of patients colonized with antimicrobial-resistant P. aeruginosa first isolates before and after the antimicrobial stewardship program. Our analysis shows that the reported decrease in the number of patients colonized was due to treating fewer patients, while the reported decrease in the number of patients colonized with resistant P. aeruginosa was due to the combined effect of treating fewer patients and altering the types of antimicrobials prescribed. We also find that shortening the average duration of treatment was unlikely to have produced any noticeable effects and that further reducing the fraction of patients prescribed antimicrobials would most substantially reduce P. aeruginosa antimicrobial resistance in the future. The analytical framework that we derive considers the effect of colonization pressure on infection spread and can be used to interpret clinical antimicrobial resistance data to assess different aspects of antimicrobial stewardship within the ecological context of the intensive care unit.<br /> (Copyright © 2012 Elsevier B.V. All rights reserved.)
- Subjects :
- Anti-Bacterial Agents therapeutic use
Humans
Mathematical Computing
Microbial Sensitivity Tests
Models, Theoretical
Ontario
Pseudomonas Infections microbiology
Anti-Bacterial Agents pharmacology
Drug Prescriptions standards
Drug Prescriptions statistics & numerical data
Drug Resistance, Bacterial
Intensive Care Units
Pseudomonas Infections drug therapy
Pseudomonas aeruginosa drug effects
Pseudomonas aeruginosa isolation & purification
Subjects
Details
- Language :
- English
- ISSN :
- 1878-0067
- Volume :
- 4
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Epidemics
- Publication Type :
- Academic Journal
- Accession number :
- 23351372
- Full Text :
- https://doi.org/10.1016/j.epidem.2012.12.001