Antibiotic use profile in a South African paediatric intensive care unit: A Prospective cohort description
Date
2022-10
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH ABSTRACT: Background Antibiotic overuse and emerging bacterial resistance is a growing threat to global health and an important point of intervention to protect future effectiveness of antibiotics. Critically ill children who are admitted to an intensive care unit are generally started on broad-spectrum antibiotics as this is necessary within the first hour of identification of sepsis to improve survival. In describing the indications and patterns of antibiotic use in our PICU we aim to reveal opportunities to improve antibiotic stewardship practices and contribute to overcoming a growing problem of antimicrobial resistance.
Objectives To comprehensively describe antibiotic utilization in the PICU at Tygerberg Hospital and to assess the appropriateness of antibiotic prescribing.
Methods We conducted a prospective observational antibiotic utilization study which enrolled 150 children between 1 January 2020 and 23 March 2020.
Results There were 133 children admitted to PICU representing 150 admission episodes. The median age of the children at admission were 20.6 months (IQR 4.4 – 64.0). Hundred and five (70%) children had a medical reason for admission with sepsis being the most common diagnosis among the youngest age groups. There was a significant difference in reason for admission between the different age groups (p=0.007) with surgical reasons becoming more likely with increasing age. Of 150 admissions 70 (46.6%) were noted to have one or more comorbid conditions with chronic lung disease and prematurity being the most common. Only 93 (66.9%) of admissions had a weight for age z-score (WAZ) in the -2 to +2 z-score range. A substantial number of admissions (24.5%, n=34) had a WAZ of <-3. In 121 (80.6%) admissions patients received antibiotics in the week prior to PICU admission. There were also 7 (5.8%) instances of carbapenems given prior to PICU admission. Twenty-five admissions (16.7%) did not receive any antibiotic. The total antibiotic use was 1256 days of therapy (DOT) /1000 patient days. Most of the antibiotic prescriptions (79.6%, n=535) were classified as empiric prescriptions. Meropenem was the antibiotic most frequently started in PICU and used for the greatest total number of days (n=140). Of the 125 admissions where antibiotics were used 66 (52.8%) were appropriate
for all prescriptions and all revisions to prescriptions. We found a blood culture pathogen yield
of 11.2% and a contamination rate of 7.5%.
Conclusion
We confirmed a high rate of empiric antibiotic utilization with evidence of overuse and
inappropriate escalation decisions. Inappropriate use was mostly related to incorrect empirical
choices, and prolonged courses of antibiotics.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
Description
Thesis (MMed) -- Stellenbosch University, 2022.
Keywords
Pediatric intensive care, Drug resistance in microorganisms, Antibiotics, UCTD