Prescription and use of antibiotics at a pediatric intensive care unit in Buenos Aires City

Abstract

Antibiotics are the most prescribed drugs in pediatric intensive care units (PICU) with high impact in pathogens resistance and costs. Evaluate prescription patterns and consumption of antibiotics. From July 2006 to January 2007, monthly cross-sectional cuts were done on antibiotics use at the 1st and 7th days of prescription. A monthly antibiotics consumption average was then calculated. Of 81 patients, 41 received antibiotics, of which 34 were treated for at least seven days. 1. Mean antibiotics / patient: 83 antibiotics were used at the initial empirical treatment (meropenem 18%, vancomycin 16.8%, amikacin 16.8%, cefotaxime 13.2%, ceftazidime 6%, clarithromycin 6%, piperacillin-tazobactam 4.8%, colistin 4.8%). mean: 2 antibiotics/patient. 98 antibiotics were used at the 7th day (vancomycin 17.3%, meropenem 16.3%, amikacin 9.8%, minocycline 9.8%, colistin 9.1%, amphotericin 6.1%, trimethoprim-sulfamethoxazole 4%, ceftazidime 5.1%). Mean: 2.8 antibiotics/patient. 2. Percentage of specimen obtained: Blood culture 100%, tracheal aspirate 68%, catheter culture 54.5% 3. Percentage of patients with positive culture: Pathogens were isolated in 56.1%, of which: Bacteria in 94.3%, Gram negative non fermenting strains, in 60.6%, Enterobacteriaceae in 24.2%, Gram positive cocci in 15% and Fungi in 5.7%. 4. Percentage of adjusted antibiotic scheme: 52%. 5. Percentage of interrupted antibiotics with negative culture: 22.2%. Monthly average of consumption was: meropenem 13.44; vancomycin 10.2; cefotaxime 3.6; ceftriaxone 2.20; piperacillin-tazobactam 7.38, amikacin 2.3. Vancomicyn and carbapenems were the antibiotics of greater use as initial empirical treatment. The initial empirical scheme would have to be adjusted to the microbiological results in order to obtain a more prudent antibiotic use.