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Antibiotic prescription practices and their relationship to outcome in South African intensive care units: Findings of the Prevalence of Infection in South African Intensive Care Units (PISA) Study

2012; Volume: 102; Issue: 7 Linguagem: Inglês

Fathima Paruk, Guy A. Richards, Juan Scribante, Sats Bhagwanjee, Mervyn Mer, Helen Perrie,

Pneumonia and Respiratory Infections

Antibiotics are commonly prescribed to critically ill patients throughout the world, with rates as high as 60%. 1 A major concern is the almost universal observation that 31 - 77% of these are inappropriate. 1-5 The inappropriate use of antibiotics is associated with increased morbidity, mortality and cost, and is a major driver in the emergence of resistant pathogens. Antibiotic prescription practices in South African intensive care units (ICUs) have not been described in the public or private sectors. Apart from its economic implications, this information is relevant because of the emergence of extremely high levels of drug resistance among Gram-negative bacilli in South Africa. 6 Background. The emergence of multidrug-resistant, extensively resistant and pan-resistant pathogens and the widespread inappropriate use of antibiotics is a global catastrophe receiving increasing attention by health care authorities. The antibiotic prescription practices in public and private intensive care units (ICUs) in South Africa are unknown. Objective. To document antibiotic prescription practices in public and private ICUs in South Africa and to determine their relationship to patient outcomes. Methods. A national database of public and private ICUs in South Africa was prospectively studied using a proportional probability sampling technique. Results. Two hundred and forty-eight patients were recruited. Therapeutic antibiotics were initiated in 182 (73.5%), and 54.9% received an inappropriate antibiotic initially. De-escalation was practised in 33.3% and 19.7% of the public and private sector patients, respectively. Antibiotic duration was inappropriate in most cases. An appropriate choice of antibiotic was associated with an 11% mortality, while an inappropriate choice was associated with a 27% mortality (p=0.01). The mortality associated with appropriate or inappropriate duration of antibiotics was 17.6% and 20.6%, respectively (p=0.42). Conclusion. Inappropriate antibiotic prescription practices in ICUs in the public and private sectors in South Africa are common and are also associated with poor patient outcomes.