Evaluation of antibiotic use in Pediatric Intensive Care Unit of a developing country

Abstract

Background:Pediatric Intensive Care Unit (PICU) patients are often prescribed antibiotics with a low threshold in comparison to patients elsewhere. Irrational antibiotics use can lead to rapid emergence of drug resistance, so surveillance of their use is important.Objectives:To evaluate the use of antibiotics in relation to bacteriological findings in PICU of a Tertiary Hospital.Methods:Retrospective review of medical records of all children (age 1 month–16 years) admitted in our closed multidisciplinary-cardiothoracic PICU from January to June 2013 was performed, after approval from Ethical Review Committee. For each antibiotic, indication (prophylactic, empiric, therapeutic) and duration of use were recorded. All diagnoses of infections were recorded according to diagnostic criteria of IPSCC 2005. Results are presented as frequency and percentages and median with inter quartile range using SPSS version 19.Results:All of the total 240 patients admitted in PICU during the study period received antibiotics: 43% (n = 104) prophylactically, 42% (n = 102) empirically, and 15% (n = 15) therapeutically. Median number of antibiotic use per patient in PICU was 3, with range of 1–7. 25% received 1 antibiotic, 23% received 2 antibiotics, 29% received 3 antibiotics, and rest received ≥4 antibiotics. Most commonly used antibiotics were cefazolin, meropenem, vancomycin and ceftriaxone, and most frequently used combination was meropenem and vancomycin. In majority of the cases, (70%) empiric antibiotic combinations were stopped in 72 h.Conclusion:This is the first report of antibiotics use in PICU from our country, which shows that antibiotics are prescribed universally in our PICU. Strategies to assess the need for antibiotic use are needed.

Factors underlying the changing of antibiotics in a paediatric intensive care unit in Pietermaritzburg, KwaZulu-Natal

“…Antibiotics were administered to 75% of our study population during their stay in the PICU. This is less than what is reported from India (100%) [14] and China (95%), [15] but comparable to the Canadian experience (70 -79%). [16] This could be attributed to the nature of our PICU, which includes both high-care and ICU beds.…”

“…Most changes (89%) occurred on an empirical basis in response to the clinical condition of the patient, supported by laboratory, radiological or surgical findings. This incidence is higher than what has been reported in India (42%), [14] China (72%) [15] or Canada (27 -40%). [16] However, the inferred reasons for changing antibiotics were in keeping with international guidelines.…”

“…[16] However, the inferred reasons for changing antibiotics were in keeping with international guidelines. [5,[11][12][13] Directed therapy accounted for 5.5% of antibiotic prescription changes, which is lower than both the Indian (15%) [14] and Canadian (34%) [16] reports. The de-escalation of antibiotics accounted for 35% of the changes, which is in keeping with findings from other studies.…”

Pharmacokinetics and Target Attainment of Antibiotics in Critically Ill Children: A Systematic Review of Current Literature

“…Not unexpectedly, a large number of manuscripts focus on agents where TDM is generally applied during routine care, such as vancomycin and gentamicin, as data are relatively readily available from medical records. In contrast, to the best of our knowledge, other frequently used agents (like ceftriaxone, ceftazidime, penicillin, flucloxacillin, metronidazole) completely lack PK data in the pediatric ICU population [71,72]. In addition, only the minority of included articles (22/50) provide dosing guidance for clinicians, even though in most publications (38/50) the necessary data on Vd and Cl was available to simulate optimal dosing regimens.…”

Impact of pharmacist-led antibiotic stewardship program in a PICU of low/middle-income country

“…The use of antibiotics in paediatric intensive care units (PICU) is very high (ranging from 67% to 97%) due to several reasons including high incidence of community-acquired sepsis, healthcare-associated infections or as a postoperative prophylaxis. 1 This high antibiotic use leads to several problems including development of antibiotic resistance, drug toxicity and drug interactions. 2 The Infectious Diseases Society of America and Society for Healthcare Epidemiology of America has initiated antibiotic stewardship programme (ASP) for better delivery of antibiotics in hospitalised patients in 2007 and updated in April 2016, was also advocated by other paediatric healthcare agencies.…”