Yoğun Bakım Ünitelerinde Sepsis ve Ventilatör İlişkili Pnömonide Antibiyotik Yönetim Programının Etkileri

Abstract

In recent years, the rate of antibiotic resistance has increased significantly, whereas fewere number of new antibiotics has been developed. Antibiotic stewardship has become a very popular topic due to higher emergence of resistance in bacteria compared to other pathogens, and a higher incidence of morbidity, mortality and treatment costs in patients with serious infections caused by these pathogens, and who are treated “inappropriately”. This study was conducted in patients hospitalized in the Intensive Care Units of Hacettepe University Adult and Oncology Hospitals who were diagnosed with sepsis / septic shock or ventilator-associated pneumonia (VAP). In this study, the effects of implementation of an antimicrobial stewardship program (ASP) were investigated. Patient data were collected prospectively in two periods when local guidelines for antimicrobial use were developed and their use encouraged (Period 2), and later, when an active auditing procedure was performed on all patients treated for VIP or sepsis/septik shock (Period 3). Data obtained during these two periods were compared to those collected retrospectively. The effects of ASP were evaluated using scoring systems developed at our center for these infections. In the sepsis arm, the rate of calculating the SOFA score (p <0.001), the rate of sending samples for a complete urine test (p = 0.001) and urine culture (p = 0.003), the rate of sampling from all possible foci of infection (p <0.001) increased significantly in Period 3. The rate of taking two sets of blood cultures (p = 0.034) significantly increased in Period 2 and Period 3. The rate of C-reactive protein (CRP) and procalcitonin testing (p <0.001) before administration of antibiotic(s) is the highest in Period 3. Similarly, antibiotics were administered at the appropriate dose (p = 0.004) and with the appropriate duration of infusion (p <0.001) significantly more frequently during the period of active intervention. In the VAP arm, calculation of SOFA at the time of diagnosis was observed only in Period 3 (p = 0.027). A decrease was observed in obtaining respiratory tract samples for culture and Gram staining before antibiotic administration (p = 0.028), and administration of antibiotic(s) in accordance with the local guidelines (p=0.021) in Period 2, but they increased in Period 3. The total scores obtained from the quality scoring systems increased in both sepsis and VAP patients