PURPOSE: The aim of this study was to evaluate the appropriateness of antibiotic use at our institution, and to determine the clinical features that predict inappropriate utilization.
METHODS: Hospitalized patients’ records were screened on two separate days to identify those receiving oral or parenteral antibiotics. Patients receiving antifungal or antiviral agents were excluded. Data collected included demographics, primary service, infection treated, microbiology results, antibiotics used, therapy duration, and whether treatment was empiric or based on culture results. Appropriateness of antibiotic use was decided according to available IDSA guidelines, ATS guidelines for pneumonia and Sanford guide 2005 edition. Empiric antibiotic use was deemed acceptable if two or more SIRS criteria were present.
RESULTS: Records of 188 patients were screened–68 were receiving antibiotics. There were 56 patients on the medical service and 12 under surgical care. Antibiotics were prescribed empirically in 42 patients, prophylactically in 3 and based on microbiology data in 23. Antibiotic use was appropriate in 56 patients (82%) and inappropriate in 12 (18%). Four out of these 12 patients had excessive duration of antibiotic use, 4 needed broader spectrum antibiotics, 2 could be treated with narrower spectrum antibiotics while 2 needed no antibiotics at all. The rate of inappropriate antibiotic use was not significantly different if the infectious disease team was involved (p=0.2). However the diagnostic categories of pneumonia and UTI were statistically linked to incorrect antibiotic use (p=.036 and p=.049 respectively). Antibiotics given empirically had a substantial likelihood of misuse (27%) vs. 0% when given based on culture results (p=.004). All p-values represent Fisher Exact Tests.
CONCLUSION: Almost 1 of 5 hospitalized patients treated with antibiotics may be receiving inappropriate treatment. This was particularly true for specific disease categories (pneumonia and UTI) and when antibiotic decisions were made empirically.
CLINICAL IMPLICATIONS: Since antibiotic resistance flourishes when antimicrobial drugs are misused, more effort needs to be made to ensure that all patients receive appropriate antibiotics. Hospitals should review their unique antibiotic treatment patterns to determine potentially problematic areas of use.
DISCLOSURE: Mamoon Zihlif, None.