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KMID : 0984720030350040192
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Infection and Chemotherapy
2003 Volume.35 No. 4 p.192 ~ p.198
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The Effect of Aminoglycoside Restriction on the Resistance Pattern and Mortality of Nosocomial Bacteremia Caused by Gram-Negative Bacilli
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Oh Jong-Taek
Kim Shin-Woo
Sohn Jong-Won
Do Byung-Hun
Han Seung-Woo
Shin Byung-Chul
Park Ji-Hyun
Lee Jong-Myung
Kim Nung-Soo
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Abstract
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Objective: To evaluate the effects of an aminoglycoside restriction policy on expenditures for aminoglycosides, anticrobial resistance rates and clinicall outcome of nosocomial bacteremia caused by Gram-negative bacilli (GNB).
Methods: Starting in February, 2002, a prior consultation with an infectious disease specialist for using aminoglycoside antibiotics over 5 days was required in a 930-bed uiversity hospital. In retrospective analysis of medical records 7 months after initiation of the aminoglycoside restriction policy, sixty cases of clinically relevant nosocomial bacteremia caused by GNB were found. These bacteremic patients were compared with sixty. species-matched, control patients with nosocomial Gram negative bacteremia before the policy for total expenditures for aminoglycosides, susceptibility to antibiotics and clinical outcomes of bacteremia.
Results: Durirg the same period of 7 months before and after the restriction policy. total expenditures for aminoglycosides decreased by 44% in cost (from 465,030,841 Won to 259,618,337 Won) and the antimicrobial utilization density of aminoglycosides decreased by 42% (from 225.2 to 130.3). On the other hand, the patterns of antibiotic susceptibility and bacteremia-related in-hospital mortality rates after the policy did not show a significant change, compared with those before the policy.
Conclusion: Antibiotic restrictions are among the most popular methods to diminish the practice of antibiotic overuse in hospitals. In this study, requirement for prior approval of aminoglycoside use over 5 days led to a significant decrease in the amount and cost of total aminoglycosides without a significant change in susceptibility patterns and bacteremia-related mortality rates.
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KEYWORD
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aminoglycosides, health expenditures, bacterial drug resistance, mortality
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