Impact of a change in antibiotic prophylaxis on total antibiotic use in a surgical intensive care unit

Abstract

Objective: The aim of this study was to evaluate the impactof reducing the length of antibiotic prophylaxis for cerebrospinalshunts on total antibiotic use and key resistantpathogens. Methods: In January 2004, the use of antibiotic prophylaxiswas reduced to a single shot dose with cefuroxime in anintensive care unit (ICU). Prior to this intervention, prophylaxiswith second-generation cephalosporins was administered during the entire period of external cerebrospinal fluid (CSF) drainage. The effect on the antibiotic usedensity (AD: DDD [defined daily doses] per 1,000 patient days [pd]) was calculated prior to (January 2002-December2003) and following implementation of the intervention(January 2004-December 2006) by segmented regressionanalysis of an interrupted time series. Resistance proportions (RP) and resistance densities (RD), defined as resistantpathogen/1,000 pd of methicillin-resistant Staphylococcusaureus (MRSA), vancomycin-resistant Enterococcus faecalis orE. faecium, third-generation-resistant (3GC) Escherichia coliand Kebsiella pneumoniae, and imipenem-resistant Pseudomonusaeruginosa, were compared by the Fisher's exacttest before and after the intervention. Results: Total antibiotic use by 147 DDD/1,000 pd decreasedafter the intervention when pre-operative prophylaxis waschanged into single shot prophylaxis, from an estimated meanof 1,036 DDD/1,000 pd before the intervention to 887DDD/1,000 pd post-intervention. This decrease was primarilydue to a significant reduction in theamount of cefuroxime usedfor prophylaxis. The reduction in total antibiotic consumptionwas sustainable, and it did not increase again during the next36 months. The RR and RD of third-generation cephalosporin resistant E. coli increased after January 2004, whereas thepercentage of MRSA significantly decreased. Conclusion: Change to single shot prophylaxis along with anongoing antibiotic stewardship program resulted in a cut-backin total antibiotic use amounting to as much as 15%. It wouldtherefore appear that targeting interventions aimed at reducingantibiotic prophylaxis in surgical ICUs may be very worthwhile. © 2010 Urban & Vogel.