Title of the publicationSurveillance of Antibiotic Use and Resistance in Intensive Care Units (SARI)
Abstract

Background
The project entitled Surveillance of Antibiotic Use and Resistance in Intensive Care Units (SARI) was initiated in Germany in 2000. In this article, we describe developments in antibiotic use and resistance rates in the participating intensive care units over the years 2001–2015.

Methods
The intensive care units supplied monthly figures on patient days, antibiotic use (in defined daily doses, DDD), and resistance data for 13 pathogens. The density of antibiotic use per 1000 patient days was calculated on the basis of antibiotic use, DDD, and patient days, and the resistance density per 1000 patient days was calculated from the number of resistant pathogens.

Results
In the years 2001–2015, data on 2 920 068 patient days were collected in 77 intensive care units. The average overall antibiotic use rose by 19% over this period, with a marked increase in the density of carbapenem use (from 76 to 250 DDD per 1000 patient days, +230%) and piperacillin-tazobactam use (from 42 to 146 DDD per 1000 patient days, +247%). The proportion of Escherichia coli and Klebsiella pneumoniae isolates that were resistant to third-generation cephalosporins increased markedly initially, then remained stable over the remainder of the observation period. The proportion of methicillin-resistant Staphylococcus aureus was stable over the entire period. The rates of vancomycin resistance among Enterococcus faecium isolates and imipenem resistance among gram-negative pathogens increased from 2.3% to 13.3% and from 0.1% to 0.3%, respectively.

Conclusion
The resistance density of gram-negative multiresistant pathogens in the participating intensive care units increased markedly. The rise in imipenem-resistant pathogens arouses particular concern. The increased use of broad-spectrum/reserve antibiotics may well have contributed to this development. Efforts to use antibiotics rationally, e.g., with the support of multidisciplinary “antibiotic stewardship” teams, are therefore vitally important. As participation in SARI is voluntary, these surveillance data cannot be considered representative of Germany as a whole.

DOI10.3238/arztebl.2017.0858
Name of the first authorRemschmidt, Cornelius
Year of publication2017
Study design of the publicationCross sectional study
Method for data collection and analysis
  • Quantitative data - Quantitative data were used during the intervention
Quantitative data - Quantitative data were used during the intervention
Scientific references about the intervention or other assessment of the intervention

10. Meyer E, Jonas D, Schwab F, Rueden H, Gastmeier P, Daschner FD. Design of a surveillance system of antibiotic use and bacterial resistance in German intensive care units (SARI) Infection. 2003;31:208–215. [PubMed] [Google Scholar]
11. Meyer E, Schwab F, Jonas D, Rueden H, Gastmeier P, Daschner FD. Surveillance of antimicrobial use and antimicrobial resistance in intensive care units (SARI): 1 antimicrobial use in German intensive care units. Intensive Care Med. 2004;30:1089–1096. [PubMed] [Google Scholar]
12. Meyer E, Schwab F, Schroeren-Boersch B, Gastmeier P. Dramatic increase of third-generation cephalosporin-resistant E coli in German intensive care units: secular trends in antibiotic drug use and bacterial resistance, 2001 to 2008. Crit Care. 2010;14 [PMC free article] [PubMed] [Google Scholar]

Other references about the intervention or other assessment of the intervention

http://sari.eu-burden.info/down/protokoll.pdf

Sector
  • Human - All activities regarding organisations and individuals involved in health products and services
Sub-sectorSub-sectors are further units of demarcation within a sector E.g. awareness campaign from veterinarians to cat owners about toxoplasmosis drug resistance and transmission of resistant bacteria: ANIMAL, PETS
Subsector (human)
  • Healthcare delivery
Healthcare delivery