Usage of antibiotics in the intensive care units of an academic tertiary-level hospital

Abstract

Background: The post-antibiotic era is approaching fast as multidrug-resistant bacteria emerge and the antibiotic pipeline slows to a trickle. Antibiotic stewardship requires that antibiotics be used appropriately and as such this study reviewed the utilisation of antibiotics in five adult intensive care units (ICUs) at Charlotte Maxeke Johannesburg Academic Hospital.Methods: A retrospective, cross-sectional record review of admissions to the Coronary, Cardiothoracic, Multidisciplinary, Neurology and Trauma ICUs was conducted over one month. Information from the ICU chart was captured on a modified version of the South African Antibiotic Stewardship Programme, Antibiotic Prescription Chart.Results: A total of 204 files were reviewed with 55.2% of patients receiving antibiotics during admission. The three most frequently prescribed were amoxicillin clavulanate (n = 46), piperacillin/tazobactam (n = 32) and cefazolin (n = 28), while colistin was used on one occasion. The majority of antibiotics (84.9%) were given for five days or less. Of concern however, of 35 instances where concurrent administration of antibiotics occurred, 8 had a similar spectrum and on 7 occasions the duration of antibiotic treatment was longer than 7 days. Cultures were ordered on 228 occasions. In patients receiving antibiotics 61.6% had cultures ordered; however, only 56.3% of these were taken before or on the day that antibiotics were started.Conclusion: This study showed that generally the duration of antibiotic treatment was short, concurrent use of antibiotics was minimal and the use of a restricted formulary limited the use of specific antibiotics such as colistin. However, implementation of stewardship principles and ordering of appropriate cultures would assist in further improving appropriate use of antibiotics in the ICU setting.