Is adherence to national guidelines for parenteral empiric antibiotic therapy effective? Experience from a Sri Lankan center.

Abstract

Guidelines for the selection of empirical antibiotics have been developed to improve patient outcomes and reduce unnecessary antibiotic use. We assessed the extent of adherence to the national guidelines for the selection of parenteral empirical antibiotics for three selected infections at a tertiary care center. A prospective cross-sectional study was conducted in medical and surgical wards of a tertiary care hospital in Sri Lanka. Adult patients with a positive culture for a lower respiratory tract infection (LRTI), skin and soft tissue infection (SSTI), or urinary tract infection (UTI) and who were prescribed parenteral empirical antibiotic therapy by the attending physician were included. Bacteria were identified and antibiotic susceptibility was determined by standard microbiological methods. Adherence to the guidelines was defined as prescribing the empiric antibiotic concordant with the national guidelines on the empirical use of antibiotics. A total of 160 bacterial isolates were obtained from 158 patients with positive cultures, the majority were from UTIs (n = 56). The selection of empirical antibiotics was concordant with the national guidelines in 92.4% of patients and 29.5% of the bacterial isolates obtained from these patients were resistant to the prescribed empiric antibiotic. Only 47.5% (76/160) of the bacterial isolates were sensitive to the empiric antibiotic and therefore can be considered an appropriate antibiotic prescription. Empirical antibiotic guidelines should be updated based on the latest surveillance data and information on prevailing bacterial spectra. Antibiotic prescribing patterns and guideline concordance should be periodically evaluated to ensure whether antimicrobial stewardship programs are moving in the right direction.