This study systematically analyzed the changing trends in antibiotic use, healthcare-associated infections, and antimicrobial resistance in the surgical ICU of a Serbian tertiary teaching hospital from 2018 to 2024, highlighting the urgency of antibiotic stewardship and resistance control. The research provides long-term ecological data, emphasizing the importance of optimizing antimicrobial stewardship strategies.
Literature Overview
This paper, titled 'Antibiotic Use, Healthcare-Associated Infections, and Antimicrobial Resistance in Intensive Care Unit of a Serbian Tertiary University Hospital, 2018–2024: An Ecological Analysis', published in the journal Antibiotics, reviews and summarizes the long-term trends in antibiotic use and their association with healthcare-associated infections and antimicrobial resistance within a surgical ICU setting. The study involved data from 2055 patients, of whom 24.9% developed at least one healthcare-associated infection, revealing patterns in antibiotic use, evolution of resistance, and their potential relationship.
Background Knowledge
Healthcare-associated infections (HAIs) are common and serious clinical issues in intensive care units (ICUs), particularly in surgical ICUs, where the severity of illness and frequent use of invasive devices significantly increase infection risk. Antimicrobial resistance (AMR) represents a major global public health challenge, especially in ICUs, where the extensive use of broad-spectrum antibiotics has led to increased emergence of resistant pathogens, such as carbapenem-resistant Enterobacteriaceae. This study, using a long-term ecological design, analyzed the association between antibiotic use patterns and HAIs and AMR, with a focus on the use growth of WHO-classified 'Reserve' antibiotics (e.g., tigecycline, polymyxins, ceftazidime/avibactam) and their relationship with resistance development. The research also evaluated trends in antibiotic expenditures, finding that expenditures peaked in 2023, primarily due to increased use of Reserve antibiotics. These findings provide empirical evidence for optimizing antimicrobial stewardship strategies, particularly regarding balancing empirical therapy with resistance control in ICU settings.
Research Methods and Experiments
This study employed a retrospective ecological design to analyze trends in antibiotic use, healthcare-associated infections, and antimicrobial resistance among 2055 adult ICU patients hospitalized for over 48 hours in a Serbian tertiary university hospital from 2018 to 2024. Antibiotic use was quantified using the Defined Daily Dose (DDD) per 100 patient-days. Resistance analysis was based on phenotypic data of key pathogens such as Klebsiella pneumoniae. The study also evaluated trends in antibiotic expenditures, focusing particularly on the increased use of Reserve antibiotics and their correlation with resistance development.
Key Findings and Insights
Research Significance and Prospects
This study reveals the alarming trend of increasing antimicrobial resistance in ICU settings and the economic burden associated with increased use of Reserve antibiotics. It underscores the need for strengthened antimicrobial stewardship programs, optimized empirical treatment protocols, restricted use of Reserve antibiotics, and enhanced infection prevention and surveillance. Future research should integrate molecular typing data to analyze the transmission routes of resistance genes, providing genetic insights for precision antibiotic management.
Conclusion
This study systematically analyzed long-term trends in antibiotic use, healthcare-associated infections, and resistance patterns in the surgical ICU of a Serbian tertiary teaching hospital. It found that while overall antibiotic use remained stable, the use of Reserve antibiotics significantly increased, coinciding with rising resistance in Klebsiella pneumoniae to carbapenems and polymyxins. The incidence of healthcare-associated Clostridioides difficile infection (HA-CDI) also steadily increased during the study period, indicating the need for further optimization of antimicrobial stewardship. The research also highlights a peak in antibiotic expenditures in 2023, primarily driven by the increased use of Reserve antibiotics. These findings emphasize the critical importance of implementing antimicrobial stewardship programs (ASP) to control resistance, reduce infection rates, and alleviate economic burden. Future research should focus on molecular-level resistance surveillance and incorporate personalized treatment strategies to enhance the safety and efficacy of antibiotic therapy in ICU patients.
