[Implementation of antimicrobial resistance surveillance and antibiotic consumption in an intensive care burn department]

ABSTRACT

The increasing consumption of antibiotics in hospitals and the economic implications of this increase lead to survey this consumption in the various hospital units. Our study proposes to measure the annual antibiotic use and antimicrobial resistance in an intensive care Burn department in order to manage the control measures. The study was conducted during a 5 year period [1 January 2000 to 31 December 2004]. The average number of admissions was 204/ year and the mean number of hospitalization was 4036/year. Antimicrobial susceptibility testing was performed by disk diffusion method. Susceptibility testing data were stored in a laboratory data base using whonet 5.3 software. The consumption of following antibiotics imipenem, ceftazidime, ofloxacin, ciprofloxacin, piperacillin-tazobactam was measured by antimicrobial density [AD] which takes into account the quantity of antibiotics in Grams converted to daily defined dose [DDD] and number of hospitalization days. The daily defined dose [DDD] was proposed by WHO. The calculation of the AD for each molecule was carried out according to the following formula AD = Quantity consumed in grams for the particular antimicrobial X 1000 divided by DDD for that antimicrobial X number of days hospitalizptions. There was statistically significant relationship between increasing use of ceftazidime and ceftazidime resistant Klebsiella pneumoniae [rs =0.93; p=0.02] The use of ceftazidime was not significantly associated with resistance to this molecule in P.aeruginosa [rs =0.76; p=0.13].Concerning the fluoroquinolones, there was statistically significant relationship between increasing use of ciprofloxacin and rate ciprofloxacin resistant P.aeruginosa [rs=0.89,P=0.043]. Furthermore, the consumption of ciprofloxacin was significantly correlated to imipenem resistance in P.aeruginosa [rs = 0 .87, p= 0.05]. However, the consumption of imipenem was not significantly correlated to resistance of this drug in P.aeruginosa [rs=0.45; P=0,4]. The monitoring of both antibiotic consumption and antibiotic resistance is necessary to set up targeted policies and to control their effectiveness. Nevertheless this monitoring must be integrated into global policy of good use and control of antibiotics