Background

Antimicrobial resistance (AMR) is presently considered an emergent major global public health concern and excessive and/or inappropriate use of broad-spectrum antimicrobials contribute to the development of AMR.

Objective

To evaluate the appropriateness of carbapenems and piperacillin-tazobactam use in a tertiary care hospital.

Methods

A retrospective, observational, cross-sectional, drug-utilization study was conducted. The study included all adult hospitalized patients who had received at least one dose of the antimicrobials during their admission for the period between 1 January 2016 and 31 December 2017. The appropriateness of antimicrobial therapy was evaluated according to the Infectious Diseases Society of America (IDSA) guidelines with the consideration of the institutional antibiogram.

Results

Overall, 2731 patients received 5005 courses with one of the antimicrobials, for a total of 5045.9 defined daily doses (DDD) of imipenem-cilastatin, 6492.3 of meropenem and 15,595 of piperacillin-tazobactam (4.93, 6.34 and 15.24 DDD/100 bed days, respectively). The mean age of the patients who received either antimicrobial was 55.5 ± 20.3 years, with a 14-day average length of hospital stay. About half (52%) of the prescriptions were written for patients treated in the medical ward. Pneumonia (26.6%) and sepsis (24.9%) were the most common indication for the initiation of antimicrobial therapy. Of the assessed prescriptions, only 2787 (56.5%) were prescribed appropriately, with 2142 (43.5%) deemed inappropriate. The three most common reasons for inappropriate prescription were: the spectrum of activity was too broad (44.6%), followed by antimicrobial use without culture request (32.4%), and failure of suitable antimicrobial de-escalation (19.9%).

Conclusions

The study indicates that the overall rate of inappropriateness was high, emphasizing the need to develop initiatives to effectively improve broad-spectrum antimicrobial prescribing.

中文翻译：

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评估沙特阿拉伯一家三级医院开具碳青霉烯类和哌拉西林-他唑巴坦处方的适宜性

背景

抗菌素耐药性 (AMR) 目前被认为是一个新兴的主要全球公共卫生问题，过度和/或不当使用广谱抗菌剂会导致 AMR 的发展。

客观的

评估碳青霉烯类和哌拉西林-他唑巴坦在三级医院使用的适宜性。

方法

进行了一项回顾性、观察性、横断面的药物利用研究。该研究包括所有在 2016 年 1 月 1 日至 2017 年 12 月 31 日期间住院期间至少接受过一剂抗菌药物的成年住院患者。根据美国传染病学会 (IDSA) 评估抗菌药物治疗的适当性考虑到机构抗菌谱的指南。

结果

总体而言，2731 名患者接受了 5005 个疗程，其中一种抗微生物药物，总计 5045.9 次确定的日剂量 (DDD) 亚胺培南-西司他丁、6492.3 次美罗培南和 15,595 次哌拉西林-他唑巴坦 (4.93、6.34 和 15.24 DDD/100 床日，分别）。接受任一抗菌药物治疗的患者平均年龄为 55.5 ± 20.3 岁，平均住院时间为 14 天。大约一半（52%）的处方是为在内科病房治疗的患者开的。肺炎（26.6%）和败血症（24.9%）是开始抗菌治疗的最常见指征。在评估的处方中，只有 2787 个（56.5%）的处方是适当的，2142 个（43.5%）被认为是不适当的。处方不当的三个最常见原因是：活动范围太广（44.6%），

结论

该研究表明，总体不适当率很高，强调需要制定有效改善广谱抗菌药物处方的举措。