Evaluation of antibiotics use in a tertiary care pediatric intensive care and high-dependency unit

Abstract

Objectives: Widespread antimicrobial use, both appropriate and inappropriate is prevalent in intensive care units (ICU) leading to antimicrobial resistance. Literature from adult ICUs revealed that 68% to 80% of patients receive antibiotics. Although less documented in pediatric intensive care units (PICU) results are similar; 56% to 100% of patients receive antibiotics. We evaluated the antibiotic usage in our PICU. Methods: This is a retrospective study carried out in pediatric intensive care and high dependency unit from September 2014 to February 2017. All case records of admitted children were analysed for antibiotic usage and categorized into no antibiotic group, 1st line antibiotic group and 2nd line antibiotic group. Rational antibiotic usage was assessed in those who received antibiotics. Antibiotic usage in major disease subgroups was assessed. All the positive cultures along with their sensitivity patterns were collected and reported. Results: Out of 1760 children no, 1st line and 2nd line antibiotics were prescribed in 882(50.1%), 794(45.1) and 84(4.78%) respectively. Most commonly used antibiotics were ceftriaxone, amoxicillin-clavulanic acid, glyopeptides and meropenem. Appropriate cultures were sent in 821(93.5%) and rational antibiotic usage was found in 825(94%). An overwhelming 63% (53/84) of patients were culture positive in 2nd line antibiotic group. A total 118 (13.4%) cultures were positive. Conclusion: We found high level of rational antibiotic usage at our centre. Strategies such as, following an evidence based antibiotic policy and empowering the designated persons for every antibiotic prescription ensures rational antibiotic usage in PICU.

Keywords

• antibiotic use
• antimicrobial resistance
• children
• pediatric intensive care unit