ผลของโปรแกรมควบคุมการใช้ยาปฏิชีวนะในผู้ป่วยหนักศัลยกรรมโรงพยาบาลมหาราชนครเชียงใหม่ Effects of Antibiotic Restriction Program in Critical Care Surgery Patients at Maharaj Nakorn Chiang Mai Hospital

Abstract

Objective: To evaluate the outcome of the antibiotic restriction programwith regard to the resistance patterns of nosocomial infection betweenbefore and after program implementation. Secondary objective was tocompare mortality, antibiotic consumption and expenditure between the twoperiods. Method: In this retrospective cohort research, we recruitedpatients in critical care surgical ward at Maharaj Nakorn Chiang MaiHospital between year 2008 (before) and year 2009 – 2011 (after).Results: The findings showed an increase in the percentage of organisms’resistant to the restricted antibiotics after program implementation for bothA. baumannii and P. aeruginosa. Only the percentages of A. baumanniiresistant to meropenem and cefoperazone-sulbactam (P = 0.042 and0.018, respectively) and the percentage of P. aeruginosa resistant toimipenem (P = 0.011) before and after the program implementation werestatistically significant. However, P. aeruginosa resistant to cefoperazonesulbactamwas decreased (P = 0.375). Mortality rate did not changesignificantly after the program. There were declines of gross antibioticutilization (measured by defined daily dose, DDD/1000 patient-days) andexpenditure of all restricted antibiotics after the program (13.3% and 25.9%,respectively). Conclusion: The antibiotic restriction program by aninfectious disease specialist did not decrease the percentage of organismsresistant to the restricted antibiotics but succeed in the reduction inantibiotics utilization and expenditure, with no difference in mortality.Keywords: antibiotic restriction program, antibiotic resistance, antibioticconsumption, antibiotic expenditure