Antibiotic usage in an intensive care unit of a tertiary level public hospital

Abstract

Introduction: Antibiotic resistance presents a great challenge as the World Health Organization declared antibiotic resistance a global threat. Considering the high disease burden, prescribers are pressured to treat empirically rather than definitively especially in the intensive care units (ICU) where critically ill patients need rapid treatment. Aim: The aim of this study was to document the utilization of antibiotics in a tertiary level hospital intensive care unit. Method: This was a retrospective record review and data was collected for a two-month period in 2016 and 2017. Information was transcribed from the ICU charts. Variables included antibiotic chosen, number of antibiotics per patient, duration and frequency of treatment as well as information on the microorganisms involved. Data was analysed quantitatively using mean, median and frequency. Result: The majority (67% in 2016 and 75% in 2017) of patients admitted to the Helen Joseph Hospital (HJH) ICU during the study period were on antibiotics and the majority were treated empirically. The most frequently used antibiotics were amoxicillin/clavulanic acid followed by piperacillin/tazobactam. The majority of antibiotics stocked in the ICU were started on day zero of admission compared to the restricted antibiotics. The average antibiotic per patient was one and a maximum of three antibiotics was used concurrently. The average length of stay in HJH ICU was two days. Klebsiella pneumoniae (17%), Enterobacter cloacae (15%), Staphylococcus aureus (11%), Escherichia coli (9%) and Pseudomonas aeruginosa (6%) were the frequently most isolated pathogens. Conclusion: The study concluded that restriction of antibiotics does improve antibiotic utilization. Also the length of stay in the HJH ICU is short. Concurrent use of antibiotics was low. Furthermore, there were some antibiotics utilization patterns seen which are not

supportive for a successful antibiotic stewardship. If there are no interventions informed by utilization studies, same patterns will continue.