Ecological and economic impact of ceftazidime and probabilist antibiotherapy limitation strategy in ventilator-associated pneumonia

Aims of the study

In our intensive care unit, the ventilator-associated pneumonia coefficient and density of incidence were respectively 21 for 100 ventilated-patients, and 20 for 1000 days of ventilation. In 1995, we had observed an increase of ceftazidime-resistant Pseudomonas aeruginosa frequency. We, therefore, compared the ecology and the cost of antibiotherapy between the first 1995 semester and the first 1996 semester, after we prescribed less of ceftazidime, and we limited the probabilist treatment in only at risk patients.

Patients and methods

For suspicion of ventilator-associated pneumonia in patients presenting the criteria of Andrews we realized 75 bronchiolo-alveolar lavages in the first 1995 semester (GI) and 70 in the first 1996 semester (G2). The diagnosis of this pneumonia was positive when bacteriologic quantitative cultures were > 10⁴ cfu/ml.

Results

See table.

Between the two periods the total cost of antibiotherapy and the cost of beta-lactamins respectively decreased to 15 and 25%.

Conclusion

Our strategy was favourable for ecology and economy in our intensive care unit. These results must be confirmed during the 2 complete years.

Table