TY - JOUR
T1 - Antibiotic prescription in intensive care units in Latin America
AU - Latin American Antibiotic Use in Intensive Care Unit Group
AU - Curcio, Daniel J.
AU - Curcio, Daniel
AU - Alí, Abraham
AU - Duarte, Alejandro
AU - Defilippi Pauta, Alfredo
AU - Guerrón, Alvaro Fernando Erazo
AU - Bañales Churrut, Ana
AU - Salcedo, Blanca
AU - Paz Chávez, Carlos Humberto
AU - Ibáñez-Guzmán, Carlos
AU - Maldonado, Carlos Rebolledo
AU - Alvarado Cueto, Daniel
AU - López García, David
AU - Yepes, David
AU - Labarca, Eduardo
AU - Veloz, Electra Moreno
AU - Valencia, Erick
AU - Plano, Fabian
AU - Varón, Fabio
AU - Toapanta, Fausto Guerrero
AU - Paredes Oña, Fernando
AU - Arancibia, Francisco
AU - Molina Saldarriaga, Francisco
AU - Montufar Andrade, Franco
AU - Morales Alava, Freddy
AU - Cañarte Bermudez, Gleinner
AU - La Fuente Zerain, Gustavo
AU - Caballero Narváez, Henry
AU - Ramos Palomino, Iván
AU - Villasante, Juan Salas
AU - Villalobos Vindas, Juan
AU - Castagnino, Jorge
AU - Espitaleta Gómez, Jorge
AU - Ranero Meneses, Jorge
AU - Rojas Suarez, José
AU - Carlos Fernández Mercado, Juan
AU - Guzmán Torrico, José
AU - Vergara Centeno, José
AU - Carlos Medina, Juan
AU - Durán Pérez, Julio
AU - Marín, Karina
AU - Alba Caero, Lenny
AU - Crespo, Leonardo Durán
AU - Ferreira Cabrera, Leonina
AU - Castillo Bravo, Luis
AU - Soto Germani, Luis
AU - Carvajal Herrera, Martín
AU - Oyanguren, Martin
AU - Chung Sang, Miguel
AU - Llano, Miguel
PY - 2011/9/1
Y1 - 2011/9/1
N2 - The intensive care units (ICUs) are often considered as the epicenters of antibiotic resistance. Therefore, the total antibiotic consumption is approximately ten fold greater in ICU wards than in general hospital wards. The aim of this study was to evaluate the current use of antibiotics in Latin American ICUs. Three cross-sectional (one-day point) prevalence studies were undertaken in 43 Latin American ICUs. Of 1644 patients admitted, 688 received antibiotic treatment on the days of the study (41.8 %) and, 392 cases (57 %) were due to nosocomial-acquired infections. Of all infections, 22 % (151/688) corresponded to septic shock; and 22 % (151/688) to nosocomial pneumonia (50/151 [33 %], ventilator-associated pneumonia). In 485 patients (70.5 %), cultures were performed before starting antibiotic treatment. The most common microorganisms isolated were extended-spectrum β-lactamase Enterobacteriaceae, (30.5 %), and Pseudomonas aeruginosa (17 %). Carbapenems (imipenem or meropenem) were the antibiotics most frequently prescribed (151/688, 22 %), followed by vancomycin (103/688, 15 %), piperacillin- tazobactam (86/688, 12.5 %) and broad-spectrum cephalosporins (mainly cefepime) (83/688, 12 %). In summary, carbapenems were the most frequent antibiotics prescribed in Latin American ICUs. This practice seems justified for the high rates of ESBLproducing Gram-negatives found in our patients. Beyond this reason, the problem of bacterial resistance in LA requires that physicians improve the use of carbapenems. The high prevalence of carbapenem-resistant A. baumannii and P. aeruginosa in the region, along with the prevalence of carbapenem-resistant Enterobacteriaceae, have increased markedly. A comprehensive evidence-based stewardship program based on local antimicrobial use and resistance problems should be implemented in our clinical settings.
AB - The intensive care units (ICUs) are often considered as the epicenters of antibiotic resistance. Therefore, the total antibiotic consumption is approximately ten fold greater in ICU wards than in general hospital wards. The aim of this study was to evaluate the current use of antibiotics in Latin American ICUs. Three cross-sectional (one-day point) prevalence studies were undertaken in 43 Latin American ICUs. Of 1644 patients admitted, 688 received antibiotic treatment on the days of the study (41.8 %) and, 392 cases (57 %) were due to nosocomial-acquired infections. Of all infections, 22 % (151/688) corresponded to septic shock; and 22 % (151/688) to nosocomial pneumonia (50/151 [33 %], ventilator-associated pneumonia). In 485 patients (70.5 %), cultures were performed before starting antibiotic treatment. The most common microorganisms isolated were extended-spectrum β-lactamase Enterobacteriaceae, (30.5 %), and Pseudomonas aeruginosa (17 %). Carbapenems (imipenem or meropenem) were the antibiotics most frequently prescribed (151/688, 22 %), followed by vancomycin (103/688, 15 %), piperacillin- tazobactam (86/688, 12.5 %) and broad-spectrum cephalosporins (mainly cefepime) (83/688, 12 %). In summary, carbapenems were the most frequent antibiotics prescribed in Latin American ICUs. This practice seems justified for the high rates of ESBLproducing Gram-negatives found in our patients. Beyond this reason, the problem of bacterial resistance in LA requires that physicians improve the use of carbapenems. The high prevalence of carbapenem-resistant A. baumannii and P. aeruginosa in the region, along with the prevalence of carbapenem-resistant Enterobacteriaceae, have increased markedly. A comprehensive evidence-based stewardship program based on local antimicrobial use and resistance problems should be implemented in our clinical settings.
KW - Carbapenem
KW - Drug resistance
KW - Latin America
KW - ß-lactamases
UR - http://www.scopus.com/inward/record.url?scp=80053059966&partnerID=8YFLogxK
U2 - 10.1590/S0325-75412011000300007
DO - 10.1590/S0325-75412011000300007
M3 - Artículo en revista científica indexada
C2 - 22430995
AN - SCOPUS:80053059966
SN - 0325-7541
VL - 43
SP - 203
EP - 211
JO - Revista Argentina de Microbiologia
JF - Revista Argentina de Microbiologia
IS - 3
ER -