Monitoring of the antibiotic prescriptions in order to prevent microbial resistance in the intensive care unit in the Russian hospital

Background

This presentation shows how, at the City Hospital, it was possible to improve the quality of clinical practice in surgery departments and ICUs.

Introduction

Antibiotics play an important role in clinical practice. The expenditure on these drugs is more than 50% of the total expenditure for drugs at the hospital. Uncontrolled use of antibiotics, in the environment of intolerably poor financing of the hospitals in Russia, and the absence of adequate control of the antibiotic prescriptions induce the growth of resistance in the hospital microbial flora, and as a result the expenditure on drug treatment increases.

Methodology

An analysis of the antibiotics purchased by the administration of the hospital was made in order to determine the baseline proportions of the different classes of antibiotics in the total structure in the year 2003. The analysis showed a high percentage of beta-lactams in the structure of the antibiotics purchased (88%). The data from the Diagnostic Laboratory Center of the city were impressive: the level of Klebsiella pneumoniae producing the enlarged-spectrum beta-lactamases reached a level of 92.5% in the ICU. An analysis of patients' data at the ICU and surgical departments (in a cohort of 300) was made in order to evaluate the quality and appropriateness of the antibiotic prescriptions. An inappropriate choice of antibiotics, wrong dosage, or an incorrect timing regime were revealed in 60% of cases. The protocols of antibiotic prophylaxis and the strict rules of antibiotic prescriptions in the ICU, prepared according to the data of evidence-based medicine, were implemented.

Conclusion

The system of governance of antibiotic prescriptions, the monitoring of the microbial resistance in the ICU, and the strict adherence to the protocols of antibiotic usage have gained approval and enabled an improvement in the quality of treatment (from 60% to 30%) and a reduction of the expenditure for antibiotics (40%).