Control of nosocomial infections in ICU patients in the Pomeranian School of Medicine in Poland

Background

Antibiotics represent the most commonly prescribed medical therapies for hospitalised patients. The practice of 'spiralling empiricism' has increasingly led to the unnecessary administration of antibiotics, resulting in the emergence of infections with antibiotic-resistant bacteria.

Purpose

To define the influence of antibiotic use on the etiology of nosocomial infection.

Setting

A six-bedded surgical intensive therapy unit (ITU) in a 700-bed teaching hospital. The research was conducted from January 1995 till June 1996. In August 1995 we have changed antibiotic guidelines on our ITU (third generation cephalosporins, fluoroquinolones and vancomycin were used only as the last option and never in prevention)

Methods

We have compared three consecutive periods of 6 months (I'95, II'95, I'96). 1276 samples for microbiological culture, mainly from bronchial tree, wounds, blood and urine, were obtained in routine manner. From 60% positive cultures 1216 strains were isolated. Antibiotics consumption was expressed in defined daily dose (DDD).

Results

Over 18-months there was no statistically significant deference in mortality rate on our ITU. There were statistically lower monthly consumptions of ceftriaxone form 60 to 0 DDD (P < 0.05) and quinolones from 282 to 110 DDD (P < 0.05) in I'95 and II'95 respectively. Vancomycin use decreased from 133 DDD in I'95 to 34 DDD in I'96 (P < 0.05). There was no statistically significant increase in amount of isolated pathogen strains in analysed periods. We have observed improvement in activities of third generation cephalosporins and fluoroquinolones.

Conclusion

This study illustrates the influence of antimicrobal therapy on the species and the resistance of strains isolated in nosocomial infection. Restrictive antibiotics policy do not affect ITU outcome. Better strategies for antibiotic administration in the ITU setting may improve their efficacy and reduce costs. Therefore, antibiotic policy would be mandatory in each hospital and department.