Abstract
BackgroundInappropriate 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.MethodsA 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.ResultsDuring 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.ConclusionsAntibiotic 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
Highlights
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
The objectives of this study were to characterize antibiotic utilization, determine the appropriateness of antibiotic use by applying the Center for Disease Control and Prevention (CDC) 12-step Strategy to prevent antimicrobial resistance among hospitalized children, and study factors associated with inappropriate antibiotic prescription in a tertiary care Pediatric Intensive Care Unit (PICU)
During the study period, 497 patients were admitted to the PICU, accounting for 3009 patient days
Summary
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. Antimicrobial stewardship programs (ASPs) are recommended to decrease inappropriate antibiotic use and mitigate its effects [19, 20] This requires an understanding of current antibiotic prescription practices and rationale. Data on antibiotic prescription in our institute have been published without detailing indications, types of infections or the appropriateness of antibiotic prescriptions [21] Such information helps to quantify the problem and identify the main areas that require attention and modification through an ASP strategy. The objectives of this study were to characterize antibiotic utilization, determine the appropriateness of antibiotic use by applying the Center for Disease Control and Prevention (CDC) 12-step Strategy to prevent antimicrobial resistance among hospitalized children, and study factors associated with inappropriate antibiotic prescription in a tertiary care PICU
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