Antibiotic Prescription Patterns in aAn Intensive Care Unit in the Kingdom of Bahrain: An Observational Prospective Study (original) (raw)
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Antibiotics in ICU : The Challenges of Use, Cost and Response in a Tertiary Care Hospital
Int J Med Res Health Sci, 2018
Antibiotic resistance can lead to increased morbidity, mortality, length of hospital stay, and health care expenditures. The study is designed to observe the challenges of antibiotic consumption, related costs and their resistance pattern in critically ill patients. The study was conducted in ICU from July to December 2016, in Holy Family Red Crescent Medical College Hospital The demographic data, antibiotic sensitivity report, the administration ofdifferent classes of antibiotics as well as individual drugs and their costs were recorded. In 216 patients, meropenem was the most commonly prescribed antibiotic followed by levofloxacin and ceftriaxone. Meropenem with one or more class of antibiotics had the higher cost (1985/-and 2800/- BDT/ per day) per patient. Though the cephalosporins are the initial choice as the safest, cheaper antibiotics in developed countries, but high rate of resistance was observed in this ICU. The overall sterilization and strict control of nosocomial infections may play vital role in overcoming the challenges. Use of local antibiogram, narrow spectrum antibiotics, infectious disease specialist consultation, and restricted authorization to prescribe antibiotics can effectively shift the antibiotic sensitivity and minimize the cost in ICU stay.
Antibiotic Prescription and Cost Patterns In An Intensive Care Unit: A Review of Literature
2012
Patients admitted to the ICU are seriously ill and often suffer from chronic critical illnesses. Antibiotics are the most frequently prescribed drugs among hospitalized patients especially in intensive care and surgical department. Antibiotic to resistance of common hospital-acquired bacteria is a worldwide problem. It can lead to increased morbidity, mortality, length of hospital stay, and healthcare expenditures. An ICU of a developing country where health costs are borne by the patients and to some extent the hospitals, it is causing a huge economic burden. Institutions elsewhere in the world have enhanced patient care through therapeutic optimization of the use of antimicrobial agents through the use of antibiotic restriction policies implemented widely throughout the hospital. Knowledge of an ICUs most common bacterial isolates and their antibiotic susceptibility patterns facilitates effective empirical antibiotic therapy and supports decisions to restrict or reduce the clinica...
Indications for antibiotic use in ICU patients: a one-year prospective surveillance
Journal of Antimicrobial Chemotherapy, 1997
. Bronchoscopic techniques were used to diagnose pneumonia. In practice, BPI must be treated, but a proportion of antibiotics prescribed for non-BPI may be unnecessary. The subdivision in BPI and non-BPI may help to identify these cases. In all, 515 patients were admitted to ICU and 36% of these had at least one infection. Of all infections, 53% were ICU-acquired and 99% of these occurred in intubated patients. Antibiotics were prescribed in 61% of admissions. Of all antibiotics prescribed for therapy, 49% were for respiratory tract infections, 19% for abdominal infections and 13% for sepsis eci. Categorized by indication, 59% of all antibiotic prescriptions were for BPI, 28% for non-BPI and 13% for prophylaxis. A theoretical reduction of 25% in the number of non-BPI prescriptions would result only in a 7% decrease of total antibiotic use. We conclude that almost all antibiotics prescribed were for intubated patients and for BPI. Respiratory infections were the single most common infection and accounted for 49% of all antibiotics used. Therefore, in our setting, prevention of respiratory tract infections is probably the most effective mode to reduce antibiotic use.
Infection and Drug Resistance, 2019
Intensive care units (ICUs) are specialized units where patients with critical conditions are admitted for getting specialized and individualized medical treatment. High mortality rates have been observed in ICUs, but the exact reason and factors affecting the mortality rates have not yet been studied in the local population in Pakistan. This study was aimed to determine rational use of antibiotic therapy in ICU patients and its impact on clinical outcomes and mortality rate. This was a retrospective, longitudinal (cohort) study including 100 patients in the ICU of the largest tertiary care hospital of the capital city of Pakistan. It was observed that empiric antibiotic therapy was initiated in 68% of patients, while culture sensitivity test was conducted for only 19% of patients. Thirty-percent of patients developed nosocomial infections and empiric antibiotic therapy was not initiated for those patients (P<0.05). Irrational antibiotic prescribing was observed in 86% of patient...
General Medicine: Open Access, 2019
Background: Antibiotics are commonly administered therapies in ICU. There has been a concern over antibiotic misuse recently. ICU is both a victim and a contributor to the ongoing antibiotic misuse problem and a cause of emerging resistance among the pathogens commonly acquired in intensive care units. Because of high mortality associated with sepsis, it is a great challenge for intensive care physicians to select appropriate antibiotic sometimes without any culture and sensitivity. Similarly the time to deescalate also remains a tough call. Selection of appropriate antibiotics empirically has always been a topic of debate among Intensive Care and Infectious Disease practitioners. Objective: The aim of our pilot study was not only to assess the appropriateness of use of antibiotics in our ICU but to help us guide to design a bigger study and structure a stewardship program for ICU. Also to assess the differences among prescription of ICU and Infectious Disease Consultants. Methods: A prospective observational study in King Saud Medical City ICU following antibiotics started and stopped from 6th November 2014 to 23 rd November 2014. Study included 23 adult patients admitted with different etiologies. All 23 patients' records were shared with two alien referees (one was infectious diseases and other was ICU consultant) from other hospital. Prescribers were blinded to the fact that data was being collected for auditing and the referees were blinded to prescribers and to each other's. Results: Total 46 antibiotics were used. 40 among them were started on empirically, 6 were culture based. 31 antibiotics were stopped by ICU. 28 among these 31 antibiotics were empirical. Most of included patients responded to combination or monotherapy. Piperacillin-Tazobactam was the most commonly prescribed antibiotic. No major difference was noted among the choice of intensive care or infectious disease consultant. Conclusion: Empirical antibiotics are vital for patients admitted in ICU. We need to follow hospital's anti-biogram and stewardship programs with prompt de-escalation wherever appropriate.
Predictors of antibiotic utilization among intensive care unit patients
Journal of Chemotherapy, 2020
Increased antibiotic utilization in hospital is linked to higher total treatment costs, together with increased length of stay, surgery and emergency admission. The aim of our retrospective cohort study was to investigate predictors of antibiotic utilization per single patient from an intensive care unit (ICU) of a tertiary care, university hospital in Serbia. Average utilization of antibiotics per patient was 23.9 ± 20.4 defined daily doses (DDDs). Diagnosis of systemic infection increased antibiotics utilization per patient for 10.0 DDDs, positive blood culture for 5.4 DDDs, isolation of Pseudomonas spp. for 19.5 DDDs, isolation of Acinetobacter spp. for 6.3 DDDs and injury for 7.3 DDDs per patient. Each new day of hospitalization and each additional drug prescribed increased utilization for further 0.3 DDDs and 1.2 DDDs, respectively. Appropriate and limited use of antibiotics in ICU is of key importance for preserving their effectiveness and decrease of bacterial resistance.
Empirical use of antibiotics in adult intensive care unit: a real-life approach
Hospital Pharmacology - International Multidisciplinary Journal
Introduction: Infection is the leading cause of complications in critically ill, and its presence signifi cantly infl uences the treatment outcome. Empirical antibiotic therapy (EAT) is justifi ed if limited to the time required for isolation and identifi cation of pathogen, which is considered not to exceed 72 hours. Aim: The aim of this study was to determine the rate of prolonged empirical antibiotic therapy (PEAT) in adult intensive care unit (ICU)-treated patients at the third level hospital and to assess factors infl uencing the antibiotic prescription practice in the hospital. The study also aimed to assess in-hospital mortality in patients treated with empirical antibiotic therapy (EAT) and to fi nd parameters that were associated with fatal outcome. Subjects and Methods: Prospective observational study involved 51 consecutive patient who underwent EAT. Demographic, clinical and laboratory data were collected. The rate of PEAT was determined as the ratio of the total number of patients who received EAT longer than 72 hours divided by the total number of patients who received EAT regardless the length of its duration. Results: The rate of PEAT was 80%. In patients with diagnosed infection, length of EAT depended on the time needed for bacteria isolation. However, EAT was introduced and even prolonged in 33% of patients, in which infection was never confi rmed. In-hospital mortality was 20%, and factors associated with death outcome were ongoing sepsis and longer EAT. Conclusions: The practice of prescribing prolonged antibiotic therapy is very common in this study. This is associated with higher mortality, so it is necessary to fi nd the cost-eff ective diagnostic method that helps in adjustment of rational empirical antibiotic treatment in ICU.
Infection and Drug Resistance, 2019
Background: Intensive care units (ICUs) are specialized units where patients with critical conditions are admitted for getting specialized and individualized medical treatment. High mortality rates have been observed in ICUs, but the exact reason and factors affecting the mortality rates have not yet been studied in the local population in Pakistan. Aim: This study was aimed to determine rational use of antibiotic therapy in ICU patients and its impact on clinical outcomes and mortality rate. Methods: This was a retrospective, longitudinal (cohort) study including 100 patients in the ICU of the largest tertiary care hospital of the capital city of Pakistan. Results: It was observed that empiric antibiotic therapy was initiated in 68% of patients, while culture sensitivity test was conducted for only 19% of patients. Thirty-percent of patients developed nosocomial infections and empiric antibiotic therapy was not initiated for those patients (P<0.05). Irrational antibiotic prescribing was observed in 86% of patients, and among them, 96.5% mortality was observed (P<0.05). The overall mortality rate was 83%; even higher mortality rates were observed in patients on a ventilator, patients with serious drug-drug interactions, and patients prescribed with irrational antibiotics or nephrotoxic drugs. Adverse clinical outcomes leading to death were observed to be significantly associated (P<0.05) with irrational antibiotic prescribing, nonadjustment of doses of nephrotoxic drugs, use of steroids, and major drug-drug interactions. Conclusion: It was concluded that empiric antibiotic therapy is beneficial in patients and leads to a reduction in the mortality rate. Factors including irrational antibiotic selection, prescribing contraindicated drug combinations, and use of nephrotoxic drugs were associated with high mortality rate and poor clinical outcomes.
Icu Antibiotic Therapy Dynamics: Examining Extended-Spectrum Antibiotics from Admission to Discharge
2024
This prospective observational study investigates antibiotic prescription patterns among 460 Intensive Care Unit (ICU) patients in Karachi, Pakistan, with a specific focus on extended-spectrum antibiotics. The study analyzes data from the first to the last day of admission, exploring mono and combination antibiotic therapies and their association with extended-spectrum regimens. The findings reveal dynamic shifts in antibiotic utilization, with a notable decrease in combination therapies over the ICU stay. Examining the extended-spectrum antibiotic, the study identifies a significant increase in monotherapy on the last day of admission. This reflects a potential refinement in antibiotic choices as patients progress through their ICU stay. Notably, the association analysis highlights a significant link between extended-spectrum antibiotics and the choice between mono and combination therapy on the last day, emphasizing the evolving nature of antibiotic decisionmaking in critical care settings. The results underscore the importance of ongoing monitoring and adaptation of antibiotic regimens based on clinical responses and microbial data. The study contributes valuable insights for antibiotic stewardship in the ICU, emphasizing the need for regular reassessment and adjustment of treatment plans. While acknowledging study limitations, including its prospective nature, these findings provide a foundation for future research aimed at optimizing antibiotic use and improving patient outcomes in critical care settings.
ANALYSIS OF ANTIBIOTIC USAGE IN INTENSIVE CARE UNIT (ICU) IN A TERTIARY CARE HOSPITAL
ARTICLE INFO ABSTRACT INTRODUCTION: Over the past decade it has been seen that antibiotic use is rising internationally. Recent reports have shown that there is increased antimicrobial resistance in India. It is a well-known fact that antibiotic misuse has been implicated in clinical, economic and environmental burden; which in turn results in the development of resistance. OBJECTIVE: This surveillance study was done with the objective of describing the antimicrobial prescribing practices in ICU using the WHO prescribing indicators. METHODS: This cross sectional study was conducted in the Medical Records Department of a tertiary care hospital in South India. Hundred prescribing encounters from ICU were collected in a random manner from January 2015 – December 2015. These encounters were analyzed using WHO Antimicrobial Use Indicators. RESULTS: In our study we found that 66% of the patients who was admitted to the hospital received at least one antibiotic. The average number of antimicrobials prescribed per hospitalization was 21.21%. The percentage of generic prescriptions was 61.35%. Only 73.09% of prescribed doses were administered. The average duration of hospital stay was 10.96 days. Antibiotic sensitivity testing was done in 40.90% of the hospitalized patients who were started on antimicrobials. CONCLUSION: The results of this study show that there is a need for strict vigilance of antimicrobial use. Standard treatment guidelines have to be formulated according to the prevalence of diseases and microbial resistance.