Antimicrobial consumption in three pediatric and neonatal intensive care units in Saudi Arabia: 33-month surveillance study

Abstract

Background Despite their critical role in antimicrobial stewardship programs, data on antimicrobial consumption among the pediatric and neonatal population is limited internationally and lacking in Saudi Arabia. The current study was done as part of our antimicrobial stewardship activities. Objectives To calculate overall and type-specific antimicrobial consumption. Methods A prospective surveillance study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between October 2012 and June 2015 in two pediatric and one neonatal intensive care units (ICUs). Consumption data were collected manually on a daily basis by infection control practitioners. Data were presented as days of therapy (DOT) per 1000 patient-days and as frequency of daily consumption. Results During the 33 months of the study, a total of 30,110 DOTs were monitored during 4921 admissions contributing 62,606 patient-days. Cephalosporins represented 38.0% of monitored antimicrobials in pediatric ICUs followed by vancomycin (21.9%), carbapenems (14.0%), aminoglycosides (8.8%), and piperacillin/tazobactam (8.8%). Their consumption rates were 265.1, 152.6, 97.6, 61.4, and 61.4 DOTs per 1000 patient-days (respectively). Aminoglycosides represented 45.4% of monitored antimicrobials in neonatal ICU followed by cephalosporins (30.4%) vancomycin (13.6%), and carbapenems (8.3%). Their consumption rates were 147.5, 98.7, 44.3, and 27 DOTs per 1000 patient-days (respectively). Conclusion Cephalosporins are frequently used in pediatric ICU while aminoglycosides are frequently used in neonatal ICU. The local consumption of cephalosporins and carbapenems in both ICUs is probably higher than international levels. Such data can help in establishing and monitoring the functions of antimicrobial stewardship activities aiming to ensure judicious consumption of antimicrobials.

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

“…DOTs per 1000 patient-days, indicating a rising increment with regard for the 708.3 DOTs per 1000 patient-days previously reported between 2012 and 2015 [22]. This difference may be attributable to seasonal variation because prescription rates increased during winter months in our study period [31].…”

“…[22] conducted a prospective surveillance study over 33 months in two PICUs and one neonatal intensive care unit (NICU) [22]. They reported that the consumption of cephalosporins (237.3 DOT per 1000 patient-days) and carbapenems (85.8 DOT per 1000 patient-days) was higher in PICU patients in Saudi Arabia than the levels reported in the USA and Canada.…”

“…To initiate ASPs and reduce the inappropriate prescription of antibiotics, it is important to first understand antibiotic utilization practices. Balkhy et al [22] presented data on antibiotic consumption in our institute but did not elaborate on indications, types of infections or the appropriateness of antibiotic prescriptions. Such information helps quantify the problem of inappropriate antibiotic use and identify the main areas that require attention and modification through an ASP strategy.…”

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

“…Total antibiotic consumption was 848.5 DOTs per 1000 patient days, indicating a rising increment from 708.3 DOTs per 1000 patient-days previously reported between 2012 and 2015 [ 21 ]. This difference may be attributable in part, to seasonal variation and an increase in prescriptions during winter months in our study period [ 27 ].…”

“…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.…”