Differences in antimicrobial consumption, prescribing and isolation rate of multidrug resistant Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii on surgical and medical wards

Abstract

In order to provide guidance data for clinically rational use of an antibiotics consuption, prescribing and prevalence of multidrug resistant (MDR) Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii were monitored on the surgical (S) and medical (M) wards of the University Hospital Center "Dr. Dragisa Misovic-Dedinje" (Belgrade, Serbia), in the study period from 2012 to 2015. Appropriateness of antimicrobial use was evaluated using the Global-Prevalence Survey method designed by the University of Antwerp. The percentages of MDR pathogens relative to the total number of isolates of K. pneumoniae and P. aeruginosa were higher on the S (86.2% and 49.1%) than on the M (63.2% and 36.9%) wards. The percentage of MDR A. baumannii was not different between S (93.7%) and M (79.5%) wards. An overall antibiotics consumption (defined daily doses/100 bed-days) during study was 369.7 and 261.5 on the S and M wards, respectively. A total of 225 prescriptions of antimicrobials were evaluated in138 adults admitted to wards on the day of the survey. The percentage of antimicrobials prescribed for prophylaxis on the M and S wards were 0% and 25%, respectively. Therapies were more frequently empiric (S, 86.8% and M, 80%). The percentages of medical errors on the S and M wards were 74.6% and 27.3%, respectively. The quality indicators for antibiotic prescribing on the S and M wards were as follows: the incorrect choice of antimicrobials (35.6% vs. 20.0%), inappropriate dose interval (70.6% vs. 16.9%) or duration of therapy (72.5% vs. 23.1%), a non-documented stop/review data (73.6% vs. 16.9%) and divergence from guidelines (71.9% vs. 23.1%). Treatment based on biomarkers was more common on the M wards as compared to the S wards. The increasing prevalence of MDR pathogens, a very high consumption and incorrect prescribing of antimicrobials need special attention, particularly on the S wards.

Fig 1. Annual distribution of Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii strains isolated on surgical (S) and medical (M) wards from 2012 to 2015.

Fig 2. Association between antimicrobial consumption and isolation rate of multi drugs resistant K. pneumoniae, P. aeruginosa and A. baumannii at surgical (A) and medical (B) wards.

Fig 3. Trends of antibiotic consumption by individual drugs on surgical (A) and medical (B) wards from 2012 to 2015.

A. *There was a statistically significant decrease in the use of amoxicillin/clavulanate (b = -2.881; p = 0.014). B. *There was a statistically significant decrease in the use of ceftriaxone (b = -2.925; p = 0.047). **There was a statistically significant increase in the use of levofloxacin (b = 2.745; p = 0.014). ***There was a statistically significant increase in the use of metronidazole (b = 1.385; p = 0.029).