Evaluating antimicrobial appropriateness in a tertiary care pediatric ICU in Saudi Arabia: a retrospective cohort study
- PDF / 1,095,726 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 80 Downloads / 216 Views
(2020) 9:173
Open Access
RESEARCH
Evaluating antimicrobial appropriateness in a tertiary care pediatric ICU in Saudi Arabia: a retrospective cohort study Yasser M. Kazzaz1,2,3* , Haneen AlTurki1,3, Lama Aleisa1,3, Bashaer Alahmadi1,3, Nora Alfattoh1,3 and Nadia Alattas1,2
Abstract Background: Inappropriate antibiotic utilization is associated with the emergence of antimicrobial resistance (AMR) and a decline in antibiotic susceptibility in many pathogenic organisms isolated in intensive care units. Antibiotic stewardship programs (ASPs) have been recommended as a strategy to reduce and delay the impact of AMR. A crucial step in ASPs is understanding antibiotic utilization practices and quantifying the problem of inappropriate antibiotic use to support a targeted solution. We aim to characterize antibiotic utilization and determine the appropriateness of antibiotic prescription in a tertiary care pediatric intensive care unit. Methods: A retrospective cohort study was conducted at King Abdullah Specialized Children’s Hospital, Riyadh, Saudi Arabia, over a 6-month period. Days of therapy (DOT) and DOT per 1000 patient-days were used as measures of antibiotic consumption. The appropriateness of antibiotic use was assessed by two independent pediatric infectious disease physicians based on the Centers for Disease Control and Prevention 12-step Campaign to prevent antimicrobial resistance among hospitalized children. Results: During the study period, 497 patients were admitted to the PICU, accounting for 3009 patient-days. A total of 274 antibiotic courses were administered over 2553 antibiotic days. Forty-eight percent of antibiotic courses were found to be nonadherent to at least 1 CDC step. The top reasons were inappropriate antibiotic choice (empirical or definitive) and inappropriate prophylaxis durations. Cefazolin and vancomycin contributed to the highest percentage of inappropriate DOTs. Conclusions: Antibiotic consumption was high with significant inappropriate utilization. These data could inform decision-making in antimicrobial stewardship programs and strategies. The CDC steps provide a more objective tool and limit biases when assessing antibiotic appropriateness Keywords: Saudi Arabia, Children, Days of therapy, Antibiotics, Antimicrobial stewardship, Antimicrobial resistance Background Antibiotics are the most common medications prescribed in pediatric intensive care units (PICUs), with up to 50–100% of patients receiving an antibiotic *Correspondence: [email protected] 1 Department of Pediatrics, Ministry of National Guards - Health Affairs, Riyadh, Kingdom of Saudi Arabia Full list of author information is available at the end of the article
prescription [1–5]. Patients in a PICU setting have a high prevalence of community and hospital-acquired infections and an overall high risk of morbidity and mortality [6–8]. However, antibiotics are not justified in every case and their prescription may signify a lack of judicious use or improper reasoning. It has been found that almost 20–50% of all an
Data Loading...
