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. 2022 Aug 30;11(9):1172.
doi: 10.3390/antibiotics11091172.

Plethora of Antibiotics Usage and Evaluation of Carbapenem Prescribing Pattern in Intensive Care Units: A Single-Center Experience of Malaysian Academic Hospital

Chee Lan Lau  1   2 , Petrick Periyasamy  3 , Muhd Nordin Saud  2 , Sarah Anne Robert  2 , Lay Yen Gan  2 , Suet Yin Chin  2 , Kiew Bing Pau  2 , Shue Hong Kong  2 , Farah Waheeda Tajurudin  2 , Mei Kuen Yin  2 , Sheah Lin Ghan  2 , Nur Jannah Azman  2 , Xin Yun Chua  2 , Poy Kei Lye  2 , Stephanie Wai Yee Tan  2 , Dexter Van Dort  2 , Ramliza Ramli  4 , Toh Leong Tan  5 , Aliza Mohamad Yusof  6 , Saw Kian Cheah  6 , Wan Rahiza Wan Mat  6 , Isa Naina-Mohamed  1
Affiliations

Plethora of Antibiotics Usage and Evaluation of Carbapenem Prescribing Pattern in Intensive Care Units: A Single-Center Experience of Malaysian Academic Hospital

Chee Lan Lau et al. Antibiotics (Basel). .

Abstract

Excessive antibiotic consumption is still common among critically ill patients admitted to intensive care units (ICU), especially during the coronavirus disease 2019 (COVID-19) period. Moreover, information regarding antimicrobial consumption among ICUs in South-East Asia remains scarce and limited. This study aims to determine antibiotics utilization in ICUs by measuring antibiotics consumption over the past six years (2016−2021) and specifically evaluating carbapenems prescribed in a COVID-19 ICU and a general intensive care unit (GICU) during the second year of the COVID-19 pandemic. (2) Methods: This is a retrospective cross-sectional observational analysis of antibiotics consumption and carbapenems prescriptions. Antibiotic utilization data were estimated using the WHO Defined Daily Doses (DDD). Carbapenems prescription information was extracted from the audits conducted by ward pharmacists. Patients who were prescribed carbapenems during their admission to COVID-19 ICU and GICU were included. Patients who passed away before being reviewed by the pharmacists were excluded. (3) Results: In general, antibiotics consumption increased markedly in the year 2021 when compared to previous years. Majority of carbapenems were prescribed empirically (86.8%). Comparing COVID-19 ICU and GICU, the reasons for empirical carbapenems therapy in COVID-19 ICU was predominantly for therapy escalation (64.7% COVID-19 ICU vs. 34% GICU, p < 0.001), whereas empirical prescription in GICU was for coverage of extended-spectrum beta-lactamases (ESBL) gram-negative bacteria (GNB) (45.3% GICU vs. 22.4% COVID-19 ICU, p = 0.005). Despite microbiological evidence, the empirical carbapenems were continued for a median (interquartile range (IQR)) of seven (5−8) days. This implies the need for a rapid diagnostic assay on direct specimens, together with comprehensive antimicrobial stewardship (AMS) discourse with intensivists to address this issue.

Keywords: antibiotics utilization; carbapenems; defined daily dose; empiric; intensive care.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Annual Antibiotic Utilization in COVID-19 ICU and GICU from the year 2016 to the year 2021.
Figure 2
Figure 2
The selection process for eligible carbapenems prescriptions.
See this image and copyright information in PMC

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