INTRODUCTIONUrinary tract infections remain one of the most frequently encountered acquired complications in an intensive care unit (ICU). The objective of this study was to determine the incidence, risk factors, microbial sensitivity patterns, and clinical outcomes of patients with UTIs acquired during their admission to an ICU in an acute care hospital in Singapore.

MATERIALS AND METHODSThis was a 14-week prospective study. All ICU patients > or =18 years who remained in the ICU for > or =48 hours were eligible for this study. Patients were reviewed daily and the presence of an ICU-acquired UTI was identified via urinary microscopic examination or culture results. Other data collected included patient demographics, ICU admission criteria, concomitant illnesses, presence of invasive lines, microbial sensitivity and treatment outcomes.

RESULTSThirty-fi ve (13.7%) cases of ICU-acquired UTI occurred in 256 separate ICU admissions. The most common micro-organisms isolated were Candida spp. (34%). Female gender and prior exposure to antibiotics were independent risk factors for developing an ICU-acquired UTI (P <0.01). Both mean length of ICU stay and duration of catheterisation were significantly longer for patients with ICU-acquired UTI (P <0.001). The mortality rate of patients with ICU-acquired UTIs (12.1%) was slightly higher than those without (9.9%).

CONCLUSIONSThe incidence of ICU-acquired UTIs was similar to figures reported for nosocomial UTIs from the previous studies. Significant risk factors for developing an ICU-acquired UTI were female gender and history of antibiotic exposure prior to ICU admission. The insignificant link between ICU-acquired UTI and mortality requires further investigation in larger cohorts.

Adult ; Aged ; Aged, 80 and over ; Cross Infection ; Female ; Humans ; Intensive Care Units ; Length of Stay ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Prospective Studies ; Risk Factors ; Singapore ; epidemiology ; Urinary Tract Infections ; epidemiology ; etiology ; physiopathology ; Young Adult

INTRODUCTIONAntimicrobial stewardship programmes (ASP) can reduce antibiotic use but patient safety concerns exist. We evaluated the safety of prospective carbapenem review and feedback and its impact on carbapenem use and patient outcomes.

MATERIALS AND METHODSAfter 3 months implementation of our ASP, we compared patients with and without acceptance of ASP recommendations on the use of carbapenems. Primary outcome was 30-day mortality. Secondary outcomes included duration of carbapenem use, length of hospitalisation, clinical response, microbiological clearance, 30-day readmission and mortality at discharge.

RESULTSOf 226 recommendations for 183 patients, 59.3% was accepted. De-escalation, switching to oral antibiotics and antibiotic cessation comprised 72% of recommendations. Patients with acceptance of ASP recommendations had lower 30-day mortality and higher end-of-therapy clinical response despite shorter carbapenem duration (P <0.05). Predictors of 30-day mortality were Pitt bacteraemia score (adjusted odds ratio [aOR] 1.39, 95% confidence interval [CI], 1.11 to 1.74; P = 0.004) and non-acceptance of ASP recommendations (aOR 2.84, 95% CI, 1.21 to 6.64; P = 0.016).

CONCLUSIONOur prospective carbapenem review and feedback mainly comprising of reducing carbapenem use is safe.

Carbapenems ; therapeutic use ; Drug Utilization ; standards ; Feedback ; Guideline Adherence ; statistics & numerical data ; Humans ; Patient Safety ; Pharmaceutical Services ; Treatment Outcome