Antimicrobial use assessment in an intensive care unit after Stewardship Program implementation

Abstract

Objective To assess the antimicrobial use profile in an intensive care unit after Antimicrobial Stewardship Program (ASP) implementation. Method A before-after implementation program conducted from january to december 2018, in patients admitted to ICU, older than 18 years and who had microbiological analysis to support diagnosis of presumed or confirmed infection and antibiotic use. Results from before and after ASP implementation period were compared (1º semester/2018 versus 2º semester/2018). Secondary data were obtained from hospital medical records and software of studied unit. Patient distribution was analyzed, and the following variables were monitored: DDD/1000 patients-day, admitted to the ICU, number of treatment requests, mean use of antimicrobials per patient, antibiotic consumption ratio, following the AWaRe classification. The t-Student test with unequal variances was used for statistical analysis, t-Student test with equal variances, and Mann-Whitney test. Results A total of 461 patients were included in the study. Meropenem was the most consumed antimicrobial in both semesters assessed (696.67 ± 120.95 versus 481.08 ± 145.23), followed by Vancomycin (316.50 ± 59.89 versus 311.71 ± 89.52) according to DDD/1000 patient-days. For ASP post-intervention period, a significant reduction in DDD/1000 patient-days was evidenced for Meropenem (p = 0.020) and Polymyxin B (p = 0.007). There was a significant increase in Piperacillin/Tazobactam variable in the post ASP period (p = 0.034). A total of 1,605 antimicrobial treatment requests were observed in 2018, with a significant reduction after ASP intervention (147.50 ± 16.63 versus 120.00 ± 18.34, p = 0.022). Regarding the AWaRe classification, the most used antibiotics in 2018, in both semesters, corresponded to “Watch” (64%), followed by “Reserve” (21%) and finally, “Access” (15%). Conclusion The findings showed a reduction in antimicrobial use after ASP application, particularly broad-spectrum antibiotics, which was expected since this is an important tool in managing antimicrobial therapy in patients affected by infection in the care unit critics.