| Summary: | Many antibiotics have been developed and are available on the market. An increase in
the use of antibiotics in hospitals was observed and antibiotics are among the
medicines most commonly prescribed to paediatric patients. Resistance to antibiotics is
increasing and is a major problem not only in the Paediatric Intensive Care Unit at
Universitas Hospital in Bloemfontein, but in South Africa in general. The continued
value and effectiveness of antibiotics depend on careful use to avoid bacterial
resistance from developing. Thus, guidelines for rational antibiotic use and prevention
of resistance should be developed and implemented. This requires an understanding of
the factors influencing antibiotic use in a particular setting, in this case the Paediatric
Intensive Care Unit at Universitas Hospital. Therefore, the aim of this study is to
describe the factors that influence the use of antibiotics in the Paediatric Intensive Care
Unit from 1998 to 2007.
This research consisted of a retrospective study of the records of patients admitted to
the Paediatric Intensive Care Unit from 1998 to 2007. Using a datasheet, the following
information was captured and evaluated: patientsâ demography, indication for
admission, co-morbid conditions, antibiotic and other drug therapy, culture and
sensitivity and other relevant parameters.
Of the 1 221 patients admitted during the study period, information could only be
retrieved for 967 patients, and of these 685 patients (385 males and 299 females) met
the study criteria. The Paediatric Intensive Care Unit performance, measured as
Intensive Care Unit utilisation, was optimal at 63%, implying that no patient needing
intensive care was denied. The most common conditions on admission were
respiratory (23.4%), gastro-intestinal (22%) and cardiovascular (19%) related problems.
Pneumonia (8.9%) was the most common infective condition. The most common
infective complications while in the Paediatric Intensive Care Unit were pneumonia
(35.6%), septicaemia (11.1%) and urinary tract infection (8.8%). Broad-spectrum
antibiotics were prescribed the most widely. The top ten antibiotics included cefotaxime (18.2%), amikacin (14.7%), vancomycin (9.8%), cefuroxime (8.1%) imipenem (7.5%),
metronidazole (7.2%), penicillin G (6.5%), cloxacillin (4.1%), co-trimoxazole (2.7%) and
gentamicin (2.4%).
The top ten bacteria genera cultured were Staphylococcus (29.3%), Klebsiella (11.9%),
Acinetobacter (11.7%), Pseudomonas (11.2%), Escherichia (8.5%), Enterococcus
(5.9%), Streptococcus (4.1%), Enterobacter (4.1%), Stenotrophomonas (3.4%) and
Haemophilus (2%). There was high resistance of the Staphylococcus genus to
penicillins and penicillin-allergy substitutes (>80%, with methicillin-resistance of 85%),
but no resistance to vancomycin was observed. The Klebsiella and Pseudomonas
genera exhibited considerable resistance to most aminoglycosides (40â78%) and
cephalosporins (70â100%), but Klebsiella remained sensitive to imipenem (1.9%), while
Pseudomonas was moderately sensitive to amikacin (22.9%). The nosocomial bacteria
genera Acinetobacter and Stenotrophomonas were resistant (>70%) to almost all
antibiotics excluding tobramycin (25.8%) for Acinetobacter and co-trimoxazole (10.5%)
for Stenotrophomonas.
Lastly, the persistently challenging factors that influenced antibiotic use in the Paediatric
Intensive Care Unit from 1998 to 2007 were common bacteria cultured from specific
specimens, bacterial innate resistance, interaction of bacterial and host factors (multiple
and severe infections), disease pattern, new antibiotics, overuse of antibiotics, length of
stay, personal preferences and treatment guidelines. In conclusion, it was illustrated
that bacterial resistance to antibiotics is increasing, and that antibiotic use in the
Paediatric Intensive Care Unit at Universitas Hospital was greatly influenced by the
efforts to contain antibiotic resistance.
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