Effect of systematic empiric treatment with imipenem on the bacterial ecology in a burns unit
Ronan Le Floch1, Jean François Arnould, Alain Pilorget
1Anaesthesiology and Reanimations, Pr M. PINAUD, CHU Nantes, Bd Jean Monnet, 44093 Nantes Cedex 01, France. ronan.lefloch@chu-nantes.fr
Abstract:
This study took place over 18 months and was divided into three 6 month periods. During the first and third periods, the bacterial ecology of the unit was reviewed, including the observation of bacteria which were isolated and led us to prescribe general antimicrobial therapy, and record the subsequent antibiograms that became available. During the second 6 month period, any patient developing an infection due (or possibly due) to a "Gram negative" strain received imipenem (as beta lactam antimicrobial agent), usually combined with tobramycin. The comparison between bacteria and antibiograms isolated during the first and the third periods did not show any increase in multiple resistant bacteria or imipenem resistant strains, including methicillin resistant Staphylococcus aureus (MRSA). During the third period, in comparison with the first, the number of Pseudomonas aeruginosa and Acinetobacter strains was lower; however, the number of Enterobacter and Klebsiella had increased. There was an increase of overall resistance to ticarcillin, but there was no increase in resistance to the other antimicrobials concerned in the study. Therefore, we concluded that wide use of imipenem did not impair the bacterial ecology of the unit, if used with precautions such as high dose regimen, de-escalation, and both pharmacokinetics and ecology monitoring.
Insights
Wide use of imipenem did not negatively impact bacterial ecology in a hospital unit. Monitoring and specific usage protocols prevented increased resistance to key antimicrobial agents.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Antimicrobial resistance is a growing global health concern.
- Judicious use of broad-spectrum antibiotics like imipenem is crucial in clinical settings.
- Understanding the impact of antibiotic stewardship on bacterial ecology is vital.
Purpose of the Study:
- To evaluate the effect of widespread imipenem use on bacterial ecology and antimicrobial resistance patterns.
- To assess the emergence of resistant strains, including methicillin-resistant Staphylococcus aureus (MRSA).
Main Methods:
- An 18-month study divided into three 6-month periods.
- Bacterial ecology and antibiograms were monitored during the first and third periods.
- Imipenem, often with tobramycin, was administered to patients with Gram-negative infections during the second period.
Main Results:
- No increase in multidrug-resistant bacteria or imipenem-resistant strains was observed.
- A decrease in Pseudomonas aeruginosa and Acinetobacter strains was noted.
- An increase in Enterobacter and Klebsiella strains occurred, with rising resistance to ticarcillin.
Conclusions:
- Widespread use of imipenem, when implemented with precautions, did not adversely affect the unit's bacterial ecology.
- Precautions included high-dose regimens, de-escalation strategies, and monitoring of pharmacokinetics and ecology.
- Careful antibiotic stewardship can mitigate the risk of increased antimicrobial resistance.
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