Rational use of antibiotics in an intensive care unit: a retrospective study of the impact on clinical outcomes and mortality rate
Received 17 September 2018
Accepted for publication 16 January 2019
Published 26 February 2019 Volume 2019:12 Pages 493—499
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Dr Joachim Wink
Muhammad Ali,1 Humaira Naureen,1 Muhammad Haseeb Tariq,2,3 Muhammad Junaid Farrukh,4,5 Abubakar Usman,3 Shahana Khattak,1 Hina Ahsan1
1Faculty of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan; 2Pharmaceutical Evaluation and Registration Division, Drug Regulatory Authority of Pakistan, Islamabad, Pakistan; 3Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; 4Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia; 5Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
Background: Intensive care units (ICUs) are specialized units where patients with critical conditions are admitted for getting specialized and individualized medical treatment. High mortality rates have been observed in ICUs, but the exact reason and factors affecting the mortality rates have not yet been studied in the local population in Pakistan.
Aim: This study was aimed to determine rational use of antibiotic therapy in ICU patients and its impact on clinical outcomes and mortality rate.
Methods: This was a retrospective, longitudinal (cohort) study including 100 patients in the ICU of the largest tertiary care hospital of the capital city of Pakistan.
Results: It was observed that empiric antibiotic therapy was initiated in 68% of patients, while culture sensitivity test was conducted for only 19% of patients. Thirty-percent of patients developed nosocomial infections and empiric antibiotic therapy was not initiated for those patients (P<0.05). Irrational antibiotic prescribing was observed in 86% of patients, and among them, 96.5% mortality was observed (P<0.05). The overall mortality rate was 83%; even higher mortality rates were observed in patients on a ventilator, patients with serious drug–drug interactions, and patients prescribed with irrational antibiotics or nephrotoxic drugs. Adverse clinical outcomes leading to death were observed to be significantly associated (P<0.05) with irrational antibiotic prescribing, nonadjustment of doses of nephrotoxic drugs, use of steroids, and major drug–drug interactions.
Conclusion: It was concluded that empiric antibiotic therapy is beneficial in patients and leads to a reduction in the mortality rate. Factors including irrational antibiotic selection, prescribing contraindicated drug combinations, and use of nephrotoxic drugs were associated with high mortality rate and poor clinical outcomes.
Keywords: clinical outcomes, mortality rate, intensive care unit, rational use of antibiotics, nosocomial infections, medication review
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