engleski

Antimicrobial consumption at ICUs at three university hospitals in Croatia

Aims: The selection of resistant bacteria as a result of wide and irrational use of antibiotics is predictable and cannot be avoided. Implementation of surveillance systems to monitor antibiotic use in hospitals with feedback and benchmarking of antibiotic consumption, and in concordance with educational measures, is needed. We evaluated antimicrobial consumption in ICUs at three Croatian University Hospitals (Zagreb, Rijeka, Osijek) during a period of 6 months. Methods: We used data from hospital pharmacies and administrative offices. The numerator used was DDD (defined daily dose) ; the denominator used was 100 patient-days. Results: UH Zagreb: In the 6-months period, out of 28 agents, the most prescribed was cefuroxime (11, 9% ; 98, 2 DDD/100 patient-days), followed by, amoxicillin+BLI (11, 8% ; 93, 1 DDD/100 patient-days), cefazolin (11, 1% ; 91, 8 DDD/100 patient days), meropenem (9, 2% ; 76, 5 DDD/100 patient-days), cloxacillin (9, 1% ; 75, 7 DDD/100 patient-days), ciprofloxacin (9, 0% ; 74, 7 DDD/100 patient-days), etc. Overall antibiotic consumption was 829, 9 DDD/100 patient-days. The most prescribed groups were cephalosporins (35, 3% ; 292, 7 DDD/100 patient-days), penicillins (28, 7% ; 238, 2 DDD/100 patient-days) and fluoroquinolones (11, 5% ; 95, 8 DDD/100 patient-days). UH Rijeka: Out of 23 agents, the most prescribed was metronidazole (20, 1% ; 108, 2 DDD/100 patient-days), followed by cefepime (19, 8% ; 106, 8 DDD/100 patient-days), ceftriaxone (12, 1% ; 65, 2 DDD/100 patient-days), meropenem (5, 3% ; 28, 8 DDD/100 patient-days), piperacillin/tazobactam (5, 1% ; 27, 7 DDD/100 patient-days), etc. Overall antibiotic consumption was 539, 5 DDD/100 patient-days . The most prescribed groups of antibiotics were cephalosporins (38, 8% ; 209, 4 DDD/100 patient-days), imidazoles (20, 1% ; 108, 2 DDD/100 patient-days), carbapenems (10, 3% ; 55, 4 DDD/100 patient-days). UH Osijek: Out of 22 agents, the most prescribed was amoxicillin/clavulanic acid (18, 8% ; 155 DDD/100 patient-days), metronidazole (16, 6% ; 136, 9 DDD/100 patient days), cefazolin (10, 9% ; 89, 8 DDD/100 patient-days), penicillin G (8, 6% ; 72, 9 DDD/100 patient-days), piperacillin/tazobactam (5, 7% ; 46, 9 DDD/100 patient-days), etc. Overall antibiotic consumption was 823, 2 DDD/100 patient-days. The most prescribed groups were penicillins (25, 7% ; 211, 6 DDD/100 patient-days), imidazoles (16, 6% ; 136, 9 DDD/100 patient-days) and cephalosporins (14, 5% ; 119 DDD/patient-days). Data analysis revealed significant variability in overall antibiotic consumption, as well as in the use of antibiotics and groups of antibiotics. The use of fluoroquinolones is relatively low in all evaluated ICUs. The data revealed relatively low use of 3rd generation cephalosporins and carbapenems in UH Zagreb and UH Osijek, and high use in UH Rijeka. Conclusion: Data will be further correlated with resistance patterns of gram-negative and gram-positive bacteria in ICUs to evaluate the impact of differences in antibiotic consumption on bacterial resistance.

antibiotics; ICU; utilization

DOI: 10.1111/j.1742-7843.2007.00104.x