The Effect of Aminoglycoside Restriction on the Resistance Pattern and Mortality of Nosocomial Bacteremia Caused by Gram-Negative Bacilli

Oh, Jong Taek; Kim, Shin Woo; Son, Jong Won; Do, Byung Hoon; Han, Seung Woo; Shin, Byung Chul; Park, Jee Hyun; Lee, Jong Myung; Kim, Nung Soo

Abstract

OBJECTIVE
To evaluate the effects of an aminoglycoside restriction policy on expenditures for aminoglycosides, antimicrobial resistance rates and clinical 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 university 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
During 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.