Antibiotic Surveillance in the Pediatric Intensive Care Unit (PICU) at Sanglah Hospital Denpasar in the Year of 2015-2017

Abstract

Background: Antibiotic surveillance in hospital settings is mandatory for optimal antibiotic therapy for the patient. Only a small number of studies have focused on antibiotic surveillance in hospitalized newborns, infants, and children. Objectives: The goal was to evaluate antibiotic use in our Pediatric Intensive Care Unit (PICU) and evaluate it for a possible association with the length of PICU stay. Methods: A retrospective, observational, cohort study was conducted from January 2015 to April 2017, involving subjects who were hospitalized in the PICU at Sanglah Hospital. The inclusion criteria were children aged between 1-month-12-years old, who had a blood culture and antibiotic sensitivity test result in their medical record. The exclusion criteria were incomplete medical records, blood cultures showing 2 types of bacteria at the same time (gram-positive and negative), or contaminated blood results. Factors associated with mortality were analyzed using a Chi-square test, with p < 0.05 considered to be statistically significant and the Risk Ratio (RR) of the associated factors was determined by 95% CI. Results: Multivariate analysis showed that the significant predictors of PICU length of stay were the appropriate continuation of antibiotics (RR 1.19; 95% CI 1.043 to 1.373; P = 0.047). There were also significant results for antibiotic compatibility and length of stay (RR 3.6; 95% CI 0.869 to 15.428; P = 0.049). Conclusion: Appropriate continuation of antibiotics and the compatibility of continuation antibiotics were significant predictors of length of PICU stay based on multivariate analysis.

Evaluating antimicrobial appropriateness in a tertiary care pediatric ICU in Saudi Arabia: A retrospective cohort study

“…On initiation, empiric antibiotics accounted for almost two-thirds of antibiotic prescriptions. This frequency is higher than the international rates reported in Canada and European countries (approximately 40%) and similar to those reported other countries, such as Indonesia (85%) [1,33,34]. The high rate of empiric prescriptions may be in uenced by a higher burden of infections in PICUs in Saudi Arabia.…”

Evaluating antimicrobial appropriateness in a tertiary care pediatric ICU in Saudi Arabia: A retrospective cohort study

“…On initiation, empiric antibiotics accounted for almost two-thirds of antibiotic prescriptions. This frequency is higher than the international rates reported in Canada and European countries (approximately 40%) and similar to those reported other countries, such as Indonesia (85%) [1,33,34]. The high rate of empiric prescriptions may be influenced by a higher burden of infections in PICUs in Saudi Arabia.…”

Penggunaan Antibiotik Irasional pada Pasien Anak dengan Sakit Kritis di Unit Perawatan Intensif Anak

“…Sebuah penelitian yang dilakukan di rumah sakit pendidikan di Indonesia, 84% pasien menerima terapi antibiotik dan 60% diantaranya menerima terapi antibiotik yang irasional atau tanpa indikasi yang jelas. 10 Penggunaan antibiotik dapat diklasifikasikan penggunaannya sebagai terapi empiris (diberikan jika terdapat kecurigaan klinis terhadap infeksi namun kuman penyebab belum diketahui) terapi definitif (diberikan jika kuman penyebab sudah teriden-J Indon Med Assoc, Volum: 74, Nomor: 2, April -Mei 2024 tifikasi dengan jelas), terapi profilaksis diberikan untuk mencegah kemungkinan terjadinya infeksi pada pasien berisiko, misalnya untuk pasien perioperatif. 11…”

“…Pasien yang datang ke PICU dengan gejala demam, 95% menerima terapi antibiotik parenteral, dan 30% diantaranya menggunakan kombinasi lebih dari satu jenis antibiotik. 10 Di Indonesia sendiri, penelitian yang dilakukan di RSUD Koja berdasarkan pola kuman yang telah diteliti, terdapat beberapa bakteri yang sudah resisten terhadap antibiotik spektrum luas, sehingga dipilih terapi kombinasi cefotaxime dan gentamisin sebagai terapi empirik di PICU. 13…”

“…Resistensi antibiotik selanjutnya dapat menimbulkan berbagai kerugian lain diantaranya durasi perawatan yang lebih panjang, biaya perawatan yang meningkat, dan risiko kematian yang lebih tinggi. 10 Di Pakistan lebih dari 58,7 juta penduduk hidup dibawah garis kemiskinan. Besarnya biaya kesehatan menjadi beban ekonomi bagi populasi masyarakat Pakistan.…”