CHANGING ETIOLOGICAL STRUCTURE AND OUTCOMES OF BACTERIEMIA IN SURGICAL PATIENTS AS A RESULT OF MONITORING AND MANAGEMENT OF ANTIBIOTIC RESISTANCE IN MULTIDISCIPLINARY HOSPITAL

Abstract

Objective. Evaluate the change of etiological structure and clinical outcomes of bacteremia in surgical patients after the implementation the system of monitoring and control antibiotic resistance in a multidisciplinary hospital.Materials and methods. Interventional study with historical controls. The intervention: antibiotic stewardship program, including a group of experts on antimicrobial therapy, antimicrobial therapy and prophylaxis protocols, infection control, improving hospital bacteriological laboratory, educational programs, internal audit. Study onset: June 2013. Analysis of pre-intervention (Jan. 2011-June 2013) and intervention (July 2013-Dec. 2015) periods was carried out. We assessed incidence of bacteremia caused by methicillin-resistant S. aureus (MRSA), vancomycin-resistant Enterococci (VRE), ESBL-producing Enterobacteriaceae, MDR Gram-negative nonfermenting bacteria (MDR-NFGB), incidence of candidemia, hospital length of stay (LOS) and mortality of surgical patients with bacteremia.Results. In the intervention period a significant decrease in the incidence of bacteremia caused by MDR-NFGB from 50 (14,8%) to 16 (4,7%), р<0,0001, VRE from 10 (3,0%) to 0, р=0,0008 and incidence of candidemia from 29 (8,6%) to 13 (2,8%), р=0,011, was detected. The frequency of bacteremia caused by ESBL-producing Enterobacteriae did not significantly change [103 (30,6%) vs. 86 (25,1%), р=0,124]. Number of MRSA bacteremias remained low [5 (1,5%) vs. 1 (0,3%), р=0,121]. There was a significant reduction of mortality from 36,8% до 22,3%, р<0,007 in the group of surgical patients with bacteremia. The LOS did not change significantly [34 (IQI 21-64) days и 34 (IQI 17,25-60,75) days, р=0,415].Conclusion. Implementation of system monitoring and control antimicrobial resistance in multidisciplinary hospital allows to significantly reduce mortality in surgical patients with bloodstream infections due to changes in etiological structure of bacteremia, reduction of the incidence of candidemia and bacteremia caused by MDR-NFGNB and VRE, which may be the result of improving the quality of antimicrobial therapy of severe infections.

Keywords

• surgical infection
• bacteremia
• antimicrobial resistance
• mortality in bacteraemia