Characteristics of infection in intensive care unit before (2007-2010) and after (2011-2014) the beginning of an antimicrobial stewardship program.

Objectives: To investigate the factors associated with isolates in intensive care unit (ICU) before and after an antimicrobial stewardship program.

Materials: Monocentric retrospective cohort study. Patients admitted to the ICU in 2007-2014 were included. Characteristics of patients were compared to overall ICU population. Clinical and microbiological characteristics of patients before (2007-2010) and after (2011-2014) the beginning of the AMP were compared.

Results: Overall, 5,263 patients were admitted to the ICU, 274/5,263 (5%) had a isolate during their staying. In 2011-2014, the percentage isolates reduced (7% vs 4%, ≤ .0001). Patients with had higher rates of in-hospital death (43% 20%, < .0001) than overall ICU population. In 2011-2014, rates of multidrug-resistant (11% 2%, = .0020), fluoroquinolone-resistant (35% vs 12%, < .0001), and ceftazidime-resistant (23% vs 8%, = .0009) reduced. Treatments by fluoroquinolones (36% vs 4%, ≤ .0001), carbapenems (27% vs 9%, = .0002), and third-generation cephalosporins (49% vs 12, ≤ .0001) before isolation reduced while piperacillin (0% vs 13%, < .0001) and trimethoprim-sulfamethoxazole (8% vs 26%, = .0023) increased. Endotracheal intubation reduced in 2011-2014 (61% vs 35%, < .0001). Fluoroquinolone-resistance was higher in patients who received endotracheal intubation (29% vs 17%, = .0197). Previous treatment by fluoroquinolones (OR = 2.94, = .0020) and study period (2007-2010) (OR = 2.07, = .0462) were the factors associated with fluoroquinolone-resistance at the multivariate analysis.

Conclusions: Antibiotic susceptibility in isolates was restored after the reduction of endotracheal intubation, fluoroquinolones, carbapenems, and third-generation cephalosporins and the increased use of molecules with a low ecological footprint, as piperacillin and trimethoprim-sulfamethoxazole.