Plethora of Antibiotics Usage and Evaluation of Carbapenem Prescribing Pattern in Intensive Care Units: A Single-Center Experience of Malaysian Academic Hospital.

Autor:	Lau CL; Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia.; Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia., Periyasamy P; Medical Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia., Saud MN; Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia., Robert SA; Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia., Gan LY; Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia., Chin SY; Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia., Pau KB; Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia., Kong SH; Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia., Tajurudin FW; Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia., Yin MK; Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia., Ghan SL; Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia., Azman NJ; Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia., Chua XY; Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia., Lye PK; Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia., Tan SWY; Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia., Dort DV; Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia., Ramli R; Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia., Tan TL; Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia., Mohamad Yusof A; Department of Anesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia., Cheah SK; Department of Anesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia., Wan Mat WR; Department of Anesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia., Naina-Mohamed I; Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia.
Jazyk:	angličtina
Zdroj:	Antibiotics (Basel, Switzerland) [Antibiotics (Basel)] 2022 Aug 30; Vol. 11 (9). Date of Electronic Publication: 2022 Aug 30.
DOI:	10.3390/antibiotics11091172
Abstrakt:	Excessive antibiotic consumption is still common among critically ill patients admitted to intensive care units (ICU), especially during the coronavirus disease 2019 (COVID-19) period. Moreover, information regarding antimicrobial consumption among ICUs in South-East Asia remains scarce and limited. This study aims to determine antibiotics utilization in ICUs by measuring antibiotics consumption over the past six years (2016−2021) and specifically evaluating carbapenems prescribed in a COVID-19 ICU and a general intensive care unit (GICU) during the second year of the COVID-19 pandemic. (2) Methods: This is a retrospective cross-sectional observational analysis of antibiotics consumption and carbapenems prescriptions. Antibiotic utilization data were estimated using the WHO Defined Daily Doses (DDD). Carbapenems prescription information was extracted from the audits conducted by ward pharmacists. Patients who were prescribed carbapenems during their admission to COVID-19 ICU and GICU were included. Patients who passed away before being reviewed by the pharmacists were excluded. (3) Results: In general, antibiotics consumption increased markedly in the year 2021 when compared to previous years. Majority of carbapenems were prescribed empirically (86.8%). Comparing COVID-19 ICU and GICU, the reasons for empirical carbapenems therapy in COVID-19 ICU was predominantly for therapy escalation (64.7% COVID-19 ICU vs. 34% GICU, p < 0.001), whereas empirical prescription in GICU was for coverage of extended-spectrum beta-lactamases (ESBL) gram-negative bacteria (GNB) (45.3% GICU vs. 22.4% COVID-19 ICU, p = 0.005). Despite microbiological evidence, the empirical carbapenems were continued for a median (interquartile range (IQR)) of seven (5−8) days. This implies the need for a rapid diagnostic assay on direct specimens, together with comprehensive antimicrobial stewardship (AMS) discourse with intensivists to address this issue. Competing Interests: The authors declare no conflict of interest.
Databáze:	MEDLINE
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