Strategies for appropriate antibiotic use in intensive care unit (original) (raw)
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Overview of antimicrobial therapy in intensive care units
Expert Review of Anti-infective Therapy, 2011
In the management of a patient with severe sepsis, it is important to suspect the infection early, to collect samples immediately after diagnosis and to promptly initiate a broad-spectrum antibiotic treatment. The choice of this empirical antimicrobial therapy should be based on host characteristics, site of infection, local ecology and pharmacokinetics/pharmacodynamics of antibiotics. In severe infection, guidelines recommend the use of a combination of antibiotics. After results of cultures are obtained, treatment should be re-evaluated to either de-escalate or escalate the antibiotic prescription. This is associated with optimal costs, decreased incidence of superinfection and minimal development of antimicrobial resistance. All these steps should rely on written protocols, and the compliance to these protocols should be continuously monitored in order to detect violations and implement corrective procedures.
Nepal Mediciti Medical Journal, 2023
BACKGROUND Antibiotics are the most commonly prescribed medicines in intensive care units (ICU). The irrational use of antibiotics leads to the development of multidrug-resistant organisms (MDR). The aim of the study is to determine the bacteriological profile of infections in our ICU and antibiotic prescription practice, before and after the culture results. METHODOLOGY This is a retrospective study conducted in a tertiary-level, 33-bedded ICU in Nepal to evaluate the bacteriological profile and antibiotic prescription practice. The patients who were admitted between a period of 3 months (January 2023 to March 2023) were enrolled. The data variables collected were; patients' details, culture samples sent (blood, urine, endotracheal (ET) aspirate, sputum, cerebrospinal fluid (CSF), wound swab, pleural fluid, ascitic fluid, tissue culture, and peritoneal fluid), gram stain results, culture sensitivity results, empirical antibiotics used, and change in antibiotics following culture results. RESULTS A total of 378 culture samples were obtained from 230 patients. A positive culture report was obtained for 165 (43.65%) of the 378 samples sent. Urine was the most common sample sent for microbiology (28%), followed by blood (25.3%) and sputum (22.75%). The percentage occurrence of gram-negative bacteria was 84%, while that of gram-positive bacteria was 16%. Methicillin-resistant coagulase-negative staphylococcus (MRCONS) was the most common gram-positive organism isolated (46.15%), and Klebsiella pneumoniae was the most common gram-negative organism (38.84%). Cephalosporin was the commonest group of empirical antibiotics used in our ICU, followed by carbapenem. Empirical antibiotic treatment was continued in 108 patients (47%), changed following the culture results in 92 patients (40%), and discontinued in 30 patients (13%). Escalation of antibiotics was done in 78 patients (85%) and de-escalation in 14 patients (15%). CONCLUSION Antimicrobial resistance and the irrational prescription of antibiotics can lead to a global economic burden. Hence, antibiotic stewardship programs are required to reduce the irrational prescribing patterns of antibiotics.
Management of antibiotic resistance in the intensive care unit setting
Expert Review of Anti-infective Therapy, 2010
Infections represent one of the most threatening complications for intensive care unit (ICU) patients. Approximately 50% of all ICU patients are treated for infection or suspected infection during their ICU stay, of which approximately half are acquired during the ICU stay. Multidrug-resistant (MDR) organisms are often the etiologic agents with a dramatic impact in morbidity and mortality rates. The emergence of carbapenemase-producing bacteria, in particular the emerging K. pneumoniae strains harboring the plasmid-encoded KPC-type carbapenemase and the New Delhi metallo-betalactamase 1 (NDM-1), in many countries is an example of the continuous evolution and spread of bacterial resistance. Infection prevention and control and antimicrobial stewardship programs in the ICU setting are demonstrating good results and need continuous implementation. During the past decade, the consumption of antimicrobial agents has continued to increase among ICU patients worldwide, with more than 60% of these patients treated with antimicrobials 1 . In the past decade, the frequency of administration of different classes of antimicrobials has changed, with increases in the use of carbapenems and ureidopenicillins and a decrease in that of cephalosporins 2 . Moreover, antibiotics such as colistin, fosfomycin, daptomycin, tigecycline and linezolid have been used more commonly for the treatment of MDR pathogens. Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus species, extended-spectrum b-lactamase or metallo b-lactamase-producing Enterobacteriaceae, as well as MDR Pseudomonas aeruginosa and Acinetobacter spp., represent the most common pathogens in the ICU setting. In the United States between1999 and 2007 increases of 104% and 182% in third-generation cephalosporin resistance for K. pneumoniae and E. coli, respectively, were observed. From the same study an increase of 54% in carbapenem resistance for P. aeruginosa was registered 3 . The last threat is represented by carbapenemase-producing Enterobactericeae, including emerging strains harboring the plasmid-encoded KPC-type carbapenemase and the New Delhi metallo-beta-lactamase 1 (NDM-1), among others. The NDM enzymes, first reported in 2008 from a Swedish patient of Indian origin are now found worldwide 4 and have also been transmitted to E. coli, Salmonella and P. aeruginosa 5-7 . This is a clear example of the ease and velocity of the global diffusion of resistance, in both developed and poorly resourced countries. An example of the impact of this phenomenon is found in Greece, where the proportion of imipenem-resistant K. pneumoniae increased from less than 1% in 2001 to 20% in isolates from hospital wards and 50% in isolates from ICUs in 2006 8 .
Asian Journal of Pharmaceutical and Clinical Research, 2018
Objective: To identify the pattern of drug utilization of antimicrobials in prescriptions of patients admitted at medical intensive care unit (MICU) and surgical intensive care unit (SICU) department and to analyze the utilization of different classes of drugs. Methods: A prospective observational study was carried out in 10 bedded medical and surgical intensive care unit (ICU) of tertiary care hospital, Adayar, from October 1 st 2016 to March 1 st 2016. The study was performed in 100 prescriptions. The relevant data on drug prescription of each patient were collected from in-patient records. The demographic data, disease data, and the utilization of different classes of antimicrobial agents (AMAs) were analyzed. Results: In MICU, a total of 648 drugs were prescribed during the period of stay and AMAs accounted for 15% of total drug. The average length of stay was found to be 8 (±8.73). The mean number of drugs received by patients is 11.6 ± 2 drugs. The most frequently prescribed AMAs were ceftriaxone followed by meropenem and clindamycin. Cephalosporin is commonly prescribed due to their relatively lower toxicity and broader spectrum activity. The generally prescribed AMA combination was amoxicillin + clavulanic acid (32.50%) and piperacillin + tazobactam (27.50%). The laboratory reported positive cultures for 30 patients. The most prevailing organisms were Escherichia coli (50%). In SICU, a total of 780 drugs were prescribed during the period of stay and AMAs accounted for 18% of total drug. An average of 5 (±2.0) drugs was prescribed for each patient and each prescription contains an average of 2 (±0.9) AMAs. The results indicated that ceftriaxone was the most commonly prescribed AMAs (22%), followed by meropenem (18%), ciprofloxacin (18%), and colistin (8%). A total of five AMA combination therapies were used in SICU. Among them, piperacillin+clavulanic acid (36.84%) was the most commonly prescribed combination. In the study, 30 (60 %) cases had microbial growth and have performed sensitivity test. Conclusion: A wide class and percentage of AMAs were prescribed in ICUs. There is a need of antimicrobial agent's usage guidelines and restriction policies for the rational prescribing of antimicrobials in critically ill patients.
IP Innovative Publication Pvt. Ltd, 2017
Background: To study the bacteriological profile of infections in patients admitted to ICU and to determine the antibiotic susceptibility patterns of the bacterial isolates. This study was done as Prospective study of 2 months period with a study population of patients admitted to Intensive care unit of a tertiary care hospital. Materials and Methods: Selection criteria for this study was with an inclusion criteria of patients admitted to ICU for various reasons and developing infection within 48 hours of admission and the exclusion criteria was patients admitted to ICU and not developing infection and patients admitted to ICU with an already existing infection. All the samples were processed as per standard microbiology guidelines. Results: Gram negative bacilli were predominant with 73.35% as compared to Gram positive cocci of 9.97% of the total aerobic bacteria grown from various samples of patients admitted in Intensive care unit. Escherichia coli were more common with 26.67% of the total bacteria isolated. This was followed by Acinetobacter species 16.67%, Pseudomonas aeruginosa 16.67%, Klebsiella pneumoniae 6.67% and Enterobacter species6.67%. Among the Gram positive cocci, Staphylococcus aureus was more commonly isolated with 16.67% followed by Enterococcus species 6.67% and Streptococcus species 3.30%. Antibiotic resistance was observed by most bacteria to Penicillins, third generation Cephalosporins, Fluoroquinolones like Ciprofloxacin, Cotrimoxazole. Conclusion: Multi-drug resistance is a major hurdle in treating patients admitted to ICU setting in a hospital. Regular surveillance of antibiotic susceptibility patterns is very important for setting orders to guide the clinician in choosing empirical or directed therapy of infected patients.
PATTERN OF ANTIBIOTIC USE AND THEIR RESISTANCE IN PATIENTS ADMITTED IN ICU
Prevalence of antibiotic consumption is high in critically ill patients. Besides of its economic impact, there is a chance of delayed diagnosis, difficulties in identifying causative microorganisms and the constant threat of induction of development of antibiotic resistance worsens the present situation. To analyze antibiotic consumption, antibiotic use was recorded in admitted patients in ICU during six month period by categorizing the indications for antibiotic use in both infectious and non-infectious disease in to two groups; (i) Empirical; (ii) Therapy for a bacteriologically proven infection (BPI). Among 216 patients admitted in ICU in the study period 144 cases are infectious and 72 are non-infectious. Length of stay less than 72 hours in ICU, Most of the patients (n= 133) received empirical antibiotic therapy. Staphylococcus Aureus, Acenetobactor and Pseudomonus are commonly found organism. Ceftriaxone, Meropenem and Levofloxacin were frequently used antibiotics in infectious and noninfectious cause. Antibiotic resistant shows in penicillin and cephalosporin group, whereas imipenem and meropenem were sensitive antibiotics. It may be concluded that monotherapy in non-infectious case was probably the most effective mode to reduce antibiotic use.