FACTORS INFLUENCING ANTIBIOTIC USE IN THE PAEDIATRIC INTENSIVE CARE UNIT AT UNIVERSITAS HOSPITAL FROM 1998 TO 2007

• Main Author: van Wyk, Riana
• Other Authors: Prof A Walubo
• Format: Others
• Language: en-uk
• Published: University of the Free State 2013
• Subjects: Health Sciences
• Online Access: http://etd.uovs.ac.za//theses/available/etd-06142013-152603/restricted/

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.