Antibiotic Use and Resistance at Intensive Care Unit of a Regional Public Hospital in Bali: A 3-Year Ecological Study

Antibiotic resistance at Intensive Care Unit (ICU) has been impacted by several factors, including high utilization and selectivity. The consumption rate and its selective pressure appear very extensive, with regular opportunities for cross-transmissions. In addition, ICU patients are susceptible to carriage acquisition and subsequent infections with high resistant bacteria. Therefore, this study investigates the relationship between the use and resistance of antibiotics in the ICU of a regional public hospital. The results potentially serve as confirmations for planning programs necessary to control ICU-related antibiotic consumption levels. This ecological analysis was also based on inpatient retrospective data from a regional public hospital in Bali from 2017–2019. Subsequently, the amount of intake expressed as daily doses (DDDs) per 100 patient days, and percentage of resistant bacterial isolates were examined using Spearman rank correlation. The largest segment of the antibiotics was determined by drug utilization 90% (DU90%) and the phenotypic class was defined by Centers for Disease Control and Prevention (CDC). Similarly, the most predominantly applied antibiotics were levofloxcacin, ceftriaxone, ampicillin, cefotaxime, ciprofloxacin, ampicillin-sulbactam and gentamycin. Meanwhile, the major gram-negative bacteria were Acinetobacter baumannii, Enterobacter cloacae, Enterococcus faecalis, Escherichia coli, Klebsiella pneumonia and Pseudomonas aeruginosa. Furthermore, 5 multi drug resistant (MDR) bacteria were observed, including A. baumannii, E. cloacae, E. coli, K. pneumonia and P. aeruginosa, while A. baumannii and E. cloacae occurred as carbapenem resistant (CR) and extended-spectrum cephalosporin-resistant (ESCR), respectively. However, only E. coli showed a negative significant correlation between antibiotic utilization and the percentage of ICU bacterial sensitivity (r=–0,543; p=0,024). Therefore, higher consumption of antibiotics decreases its percentage susceptibility.