الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Healthcare Associated Infections (HAIs) are an important health problem in terms of morbidities, mortalities and economic consequences, world-wide. They are especially important in intensive care units (ICUs) where they have a five-fold higher incidence rate compared to the general inpatient population. This is due to the increased use of medical instruments such as mechanical ventilators, monitoring devices, blood and urine catheters and also high resistance of the microorganisms isolated from ICUs patients to most commonly used antibiotics, which in turn is a result of over use and misuse of broad-spectrum antibacterial agents. In our setting the most common pathogen which make resistance to antibiotics are staphylococcus species, streptococcus species, enterococcus species, pseudomonas species, Acinetobacter species, Klebsiella species, E coli and Enterobacter species. These organisms are common prevalent ones and also more resistant ones in our ICU. So in this study we were trying to decrease resistance of these pathogens to our antibiotic to achieve a high standard clinical impact on our patient in mortality, morbidity and also to achieve a good economical outcome to our hospital.
Materials and methods
Study was done in ICU which consist of 14 medical beds and 11 surgical beds in general hospital which consists of 1000 beds, the scope of work is implementation of different strategies and protocol to decrease of antibiotic resistance which have a great influence in mortality and morbidity and also to decrease ICU stay which have an infinite outcome in economic and treating large number of patient who need ICU admission and could not achieve it because of bed availability. We design and implement different strategies and protocols to achieve this purpose like rotation in antibiotic classes every three months according to our ICU epidemiology and also cycling in different molecules in same class was a method to achieve this purpose by making heterogeneity in antibiotic use by the time, enhancement of antibiotic pharmacodynamics properties, for example extended and continuous infusion to beta-lactam antibiotic class also was a method to achieve this purpose by adjusting the antibiotic efficacy and finally implement of strategies to adjust antibiotic empirical therapy like de-escalation technique also was a method to achieve this purpose by adjustment antibiotic prescribing manner. All these strategies and protocols were implemented from January 2014 to December 2015 which was two years study, after December 2015 all results of two years were collected and were compared with two years results prior to January 2014. And the comparison in the different aspects which are sensitivity and resistance results, clinical outcomes like sofa score, mortality results, ICU stay results and finally financial outcomes.
It is really a very big study which had its results within four years from 2012 till 2015; whereas 3049 patients were scrutinized in it. And all results before January 2014 were collected from patient files but results from January 2014 till December 2015 were collected in different study models which are mentioned in the study and it had been collected daily in these models. And finally the results have been statistically done by statistical program which is called (IBM SPSS version 20), whereas; if P value is p<0.05 this is meaning that the results show statistically significant difference and if p<0.001 this is meaning that the results show statistically high significant difference.
Results
Finally the results were represented in different categories but all results show a significant success in different sides, whereas microbiological results which are about sensitivity and resistance lighted to significant improvement in antibiotic sensitivity to more resistant and prevalent organisms, as well patient clinical outcomes became more better and finally the financial outcomes also became more fantastic.
Conclusion
In the last of our study which was designed for decreasing resistance to antibiotic, we achieve a great success in this purpose, really this purpose is a very important to every hospital to achieve it and need more effort from high country level to help who work on it to get this purpose. But in the end we recommend to make more studies and implement more plans and protocol to achieve more results to safe our patient life.