Appropriateness of antibiotics prescribed in patients with bacteremia

Abstract

Background: Prescribing of appropriate antibiotics is particularly important in patients with bacteremia. The purpose of this work was to evaluate the appropriateness of antibiotic therapy prescribed to patients with bacteremia in our tertiary 300-bed hospital for the period 2010-2012. Methods & Materials: Blood-culture diagnostic was performed in Bactec 9050, BD, USA; positive bottles were investigated through Gram stain (immediately reported to the clinicians) and routinely cultured on blood-, MacConkey-, Sabouraux- agar; for anaerobes – on Schaedler-, for fastidious organisms – on chocolate- agar. Biochemical identification of pathogens was with API, BioMerieux, France, and Crystal, BD. Antimicrobial susceptibility tests were performed by disk diffusion method according to the CLSI, 2010. Empirical antibiotic prescription should be upon the institutional guidelines. An audit was performed to evaluate the appropriateness of antibiotic therapy. Results: Blood-cultures varied from 1700 to 1100 sets/year. Patients with bacteremia accounted for 200/100000 bed-days. The ratio ambulatory-: hospital- cases was 52%: 48%. Secondary bacteremia was more frequent than primary. The most common isolates were S. aureus, E. coli and other Enterobacteriaceae. The rate of MRSA varied from 14% to 40% and of Enterobacteriaceae - ESBL-producers – from 28 to 43%. Analysis of antibiotic prescriptions revealed that for almost half of patients with problematic antibiotic resistant pathogens the prescribed antibiotics were not appropriate. Conclusion: More precisely the risk factors for resistant pathogens should be evaluated to prescribe early appropriate antibiotics; introduction of fast diagnostic and susceptibility testing methods will further improve the prognosis of patients with bacteremia.