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Name | Impact of Antibiotic cycling Policy in Antimicrobial Resistance in Two Sudanese Surgical Wards Settings: Prospective Longitudinal Interventional Study |
Description | Original research article:- *Salah I. Kheder, Idris Eltayeb, Sania A I Shaddad, Isam Kheder. *Ph.D Pharmacology-National College of Medical & Techenical sciencies, Deputy Pharmacy Program Co-ordinator,Pharmacy program,Khartoum-3783,Sudan.
Abstract:-Background: Antimicrobial resistance is one of the biggest challenges facing global public health. In the past sixty years, many classes of antimicrobial have been developed, but duration of benefit appeared to be limited: resistance has emerged to every antimicrobial class. Antimicrobial resistance seriously hampers treatment of infections and leads to increased length of stay, morbidity, mortality and healthcare costs, both in hospital and community settings. In the era of increasing bacterial resistance and in the absence of new effective antibacterial drugs, it is necessary to use the currently available agents optimally and appropriately. Of the interventions designed to reduce antibiotic resistant rates in hospitals, where antibiotic usage is high, is antibiotic cycling or rotation. Method: A prospective quasi-experimental (pre & post intervention), nonrandomized, observational study, conducted in Ibn Sina Hospital at two surgical wards (Gastro-intestinal tract & Urology surgical wards), to evaluate the impact of antimicrobial cycling intervention in the prevalence of antimicrobial-resistance bacteria. Three antibiotic classes (cephalosporin, amoxiclave and ciprofloxacin) were systematically cycled for 3-4 months intervals over 2 years. Colonization with antibiotic-resistance bacteria was determined with intensive surveillance, through cultured a bacterial isolates taken from surgical wounds and urine and sensitivity test were performed for susceptibility. Results: In all, 1681 surveillance samples obtained from 2359 eligible patients admitted to the Ibn Sina hospital. Of these samples 345 (20.5%) obtained from GIT ward as surgical and wound swabs, 1336 (79.5%) samples obtained from urology surgical ward (1197 urine samples and 139 surgical swabs). A decrease in the mortality rate was observed when comparing between the baseline period and most of the cyclic periods for each ward, but with no significant difference. Length of stay decreased from baseline period to cyclic period for each ward (GIT 13.3± 11.8 Vs 9.6± 8.7 ,p ≤ 0.229 ; Urology 11.9± 12.42 Vs 7.1± 5.5 p≤ 0.204).As general we notice that there is a divergent effect of the antimicrobial cycling on the prevalence of bacterial resistance. A slight decrease in mean resistance percentage, (R %) for all gram-positive bacteria (GPB) between baseline and cycle (VI) in GIT ward (decreased from 79% to 73%), while there is increase in mean (R %) for all gram-negative bacteria (GNB) for the same ward during same period (increased from 89% to 100%). In urology ward an increase in mean (R%) for GPB between baseline and cycle (VI) (increased from 81% to 97%),but a decrease in mean (R%) GNB for the same ward during the same period (decreased from 88% to 78%). Conclusion: After two years follow-up our study was successes to stabilize antibiotic resistance, without significant reduction, especially when we put in consideration that the physicians' adherence to only the use of the cycled antimicrobial was poor and also erratic.
Key words: antibiotic resistance; antibiotic cycling; antibiotic rotation, antibiotic policy. |
Filename | Kheder I Salah et.al..pdf |
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Created On: | 04/18/2011 00:00 |
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Last updated on | 04/26/2011 16:17 |
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