Abstract
To measure the rate of unnecessary antimicrobials (UAU), and the effect of the infectious disease consultation. A 17-week multicenter study, patients’ records were reviewed for antimicrobials. A predefined UAU definition was developed. Excluded patients were those on prophylaxis and less than 1-year-old. The outcome is the UAU rate. Confounders were adjusted by Charlson index and APACHE 2 score. The analysis was by Χ<sup>2</sup> and Fischer's Exact Tests and multivariate analysis as appropriate. 662 records were reviewed: 169 qualified the necessary antimicrobial use (NAU) and 493 in the UAU categories. The rate of the UAU was 74.5%. The age means differed (53.85 years for the NAU versus 46.48 years for the UAU, P<0.001) without gender difference (P=0.285). The patients in the UAU category were represented more in UTI, SSTI, BSI, and no infection (P<0.05). The commonest UAU subcategory were non-infectious non-febrile conditions 36.71%, influenza-like illnesses, and viral syndromes 20.08%, combination therapy 17.6%. An infectious disease consultation was significantly associated with less UAU (P ≤ 0.004), and less mortality (P<0.05). In conclusion: UAU rate was high, and an infectious disease consultation significantly reduced the UAU rate and mortality.
Highlights
Over the past decades, the wide use of antimicrobials in combating infections saved lives, with a marked reduction in infection-related mortality and complications [1,2,3]
There was a higher proportion of the cultured microorganisms in the patients with necessary antimicrobial use (NAU) compared with the unnecessary use of antimicrobials (UAU) (P=0.000), except for P. aeruginosa and the "bacteria not identified"
The UAU rate was high in Jordan, prescribers are mostly not aware of the elements of UAU i.e. when to consider a prescription a UAU, this is possibly due to inadequate physicians' and surgeons' awareness and exposure to the multifaceted stewardship concept
Summary
The wide use of antimicrobials in combating infections saved lives, with a marked reduction in infection-related mortality and complications [1,2,3]. Due to their perceived benefits in combating infections, an inappropriate message was conveyed on their "miraculous" effects, and their use was inappropriately extrapolated to other non-infectious ailments. The unnecessary use of antimicrobials (UAU) emerged in some microbial infections and regrettably conditions other than bacterial infections, adding to the burden of bacterial resistance [4]. In an era of a shortage in new antimicrobials, the purpose of this study is to assess the rate of UAU in Jordan, attempting to understand the gravity of the problem and to help in antimicrobials’ stewardship through a wise and responsible appropriate prescribing
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