OBJECTIVES : ECDC indicates that Romania is among the member states with the highest levels of antimicrobial resistance (AMR) in Europe. However, there is no National Antimicrobial Stewardship Program (ASP) implemented to facilitate national guidelines on antibiotic prescription. Furthermore, studies using local hospital data monitoring cases with bacterial infections are scarce. The aim of this study is to estimate the inpatient average length of stay (ALoS) and observe the prescription practices when treating gram negative bacterial infections in public hospitals in Romania.

METHODS : This analysis used official disease code data reported from 515 public and private hospitals in Romania in years 2018 and 2019. We used 13 disease codes for gram negative infections mainly indicative of Klebsiella, Pseudomonas and Escheria Coli. A separate analysis using data from 21 large public hospitals investigated to what extent prescription protocols for antibiotics included a microbiologic test.

RESULTS : In 2019 we found on average 129 cases treated for gram negative bacterial infections per 100,000 per year. Of these, 31% were indicative of Klebsiella and 23% were indicative of Pseudomonas and more than a half were in the age category 60-84 years. However, only in 57% of these cases the antibiotic prescription practices included a microbiologic test. We found that the average ALoS was 12 days [95% CI: 11.3-12.2] with approximately 1.5 days [95% CI: 1.3-1.8] spent on average at the intensive care unit (ICU).

CONCLUSIONS : Considering that almost half of the patients treated with antibiotics in Romanian public hospitals did not have a bacterial microbiologic test accompanying their antibiotic (AB) treatment, we can conclude that antibiotics are often used preventively or in an ad hoc manner. An optimal use of AB treatment in Romania and a decrease of the ALoS can be achieved through the development of national guidelines on rapid diagnosis and appropriate treatment of bacterial infections.