Supervisors info:
Μπάκα Σταυρούλα, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ξάνθος Θεόδωρος, Καθηγητής, Ιατρική Σχολή, Ευρωπαϊκό Πανεπιστήμιο Κύπρου
Ιακωβίδου Νικολέττα, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Background
The current challenge for Antimicrobial Stewardship Programs (ASP) is to limit the use of “under restriction” antibiotics. The aim of the present study was to analyze prescribing of restricted antibiotics, in order to plan further actions of the ASP.
Methods
Prospectively, all prescriptions for restricted antimicrobials i.e. carbapenems, colistin, tigecycline and ceftazidime-avibactam at «Laikon» General Hospital of Athens were collected through a specific time period. The data recorded regarded information on patient demographics, form of treatment, duration of treatment, cultures obtained, and reasons for modification of treatment.
Results
We reviewed 256 prescriptions of restricted antibiotics, which accounted for 2112 Days of Therapy (DOTs). The most commonly prescribed “restricted” antibiotics were meropenem (60.9% of prescriptions) and colistin (16.4%). Empirical treatment accounted for 67.2% of prescriptions. The highest percentage of empirical prescriptions was for meropenem followed colistin at 82.1% and 50%, respectively. Most prescriptions were issued in medical wards (73.1%), with the three Internal Medicine Departments accounting for 56.9% of all prescriptions. The surgical wards issued 17.5% of prescriptions and Kidney Transplantation Unit issued 9.4%. The treatment was deemed appropriate more frequently in Surgical wards (95,6% vs 78,1%, p=0.007). The stated reasons for empirical prescription of restricted antimicrobial were recent hospitalization (125/172, 72.7%), escalation due to non-response to previous antimicrobials (82/172, 47.7%), treatment for severe sepsis/ septic shock (79/172, 45.9%), escalation due to recurrence or deterioration (38/172, 22.1%), prior multi-drug resistance (MDR) bacterial infection (35/172, 12.8%), and prior MDR bacterial colonization (13/172, 7.6%). Empirical treatment for septic shock or severe sepsis was the only significant predictor of MDR bacterial isolation (OR=5.26, 95% CI 1.5 – 18.4, p=0.009), while recent hospitalization had a high negative predictive value for MDR bacteria (97.4%).
Conclusion
in a setting with widespread antimicrobial resistance, it could be difficult to reduce the empirical use of “restricted” antibiotics without risking inadequate treatment. However, this might be possible by using decision support and diagnostic stewardship tools.
