Using Culture Sensitivity Reports to Optimize Antimicrobial Therapy: Findings and Implications of Antimicrobial Stewardship Activity in a Hospital in Pakistan
<i>Background</i><b>:</b> There are concerns with inappropriate prescribing of antibiotics in hospitals especially broad spectrum in Pakistan and the subsequent impact on antimicrobial resistance rates. One recognized way to reduce inappropriate prescribing is for empiric the...
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MDPI AG
2023-07-01
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| Online Access: | https://www.mdpi.com/1648-9144/59/7/1237 |
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| author | Ummara Altaf Zikria Saleem Muhammad Furqan Akhtar Waleed Mohammad Altowayan Abdulmajeed A. Alqasoumi Mohammed Salem Alshammari Abdul Haseeb Fahad Raees Mohammad Tarique Imam Narjis Batool Muhammad Masoom Akhtar Brian Godman |
| author_facet | Ummara Altaf Zikria Saleem Muhammad Furqan Akhtar Waleed Mohammad Altowayan Abdulmajeed A. Alqasoumi Mohammed Salem Alshammari Abdul Haseeb Fahad Raees Mohammad Tarique Imam Narjis Batool Muhammad Masoom Akhtar Brian Godman |
| author_sort | Ummara Altaf |
| collection | DOAJ |
| description | <i>Background</i><b>:</b> There are concerns with inappropriate prescribing of antibiotics in hospitals especially broad spectrum in Pakistan and the subsequent impact on antimicrobial resistance rates. One recognized way to reduce inappropriate prescribing is for empiric therapy to be adjusted according to the result of culture sensitivity reports. <i>Objective:</i> Using culture sensitivity reports to optimize antibiotic prescribing in a teaching hospital in Pakistan. <i>Methods:</i> A retrospective observational study was undertaken in Ghurki Trust Teaching Hospital. A total of 465 positive cultures were taken from patients during the study period (May 2018 and December 2018). The results of pathogen identification and susceptibility testing from patient-infected sites were assessed. Additional data was collected from the patient’s medical file. This included demographic data, sample type, causative microbe, antimicrobial treatment, and whether empiric or definitive treatment as well as medicine costs. Antimicrobial data was assessed using World Health Organization’s Defined Daily Dose methodology. <i>Results:</i> A total of 497 isolates were detected from the 465 patient samples as 32 patients had polymicrobes, which included 309 g-negative rods and 188 g-positive cocci. Out of 497 isolates, the most common Gram-positive pathogen isolated was <i>Staphylococcus aureus</i> (Methicillin-sensitive <i>Staphylococcus aureus</i>) (125) (25.1%) and the most common Gram-negative pathogen was <i>Escherichia coli</i> (140) (28.1%). Most of the gram-negative isolates were found to be resistant to ampicillin and co-amoxiclav. Most of the <i>Acinetobacter baumannii</i> isolates were resistant to carbapenems. Gram-positive bacteria showed the maximum sensitivity to linezolid and vancomycin. The most widely used antibiotics for empiric therapy were cefoperazone plus sulbactam, ceftriaxone, amikacin, vancomycin, and metronidazole whereas high use of linezolid, clindamycin, meropenem, and piperacillin + tazobactam was seen in definitive treatment. Empiric therapy was adjusted in 220 (71.1%) cases of Gram-negative infections and 134 (71.2%) cases of Gram-positive infections. Compared with empiric therapy, there was a 13.8% reduction in the number of antibiotics in definitive treatment. The average cost of antibiotics in definitive treatment was less than seen with empiric treatment (8.2%) and the length of hospitalization also decreased. <i>Conclusions:</i> Culture sensitivity reports helped reduced antibiotic utilization and costs as well as helped select the most appropriate treatment. We also found an urgent need for implementing antimicrobial stewardship programs in hospitals and the development of hospital antibiotic guidelines to reduce unnecessary prescribing of broad-spectrum antibiotics. |
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| last_indexed | 2024-03-11T00:50:38Z |
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| series | Medicina |
| spelling | doaj.art-2e9bbc6c3e5648b88003ea0aea7f01322023-11-18T20:23:48ZengMDPI AGMedicina1010-660X1648-91442023-07-01597123710.3390/medicina59071237Using Culture Sensitivity Reports to Optimize Antimicrobial Therapy: Findings and Implications of Antimicrobial Stewardship Activity in a Hospital in PakistanUmmara Altaf0Zikria Saleem1Muhammad Furqan Akhtar2Waleed Mohammad Altowayan3Abdulmajeed A. Alqasoumi4Mohammed Salem Alshammari5Abdul Haseeb6Fahad Raees7Mohammad Tarique Imam8Narjis Batool9Muhammad Masoom Akhtar10Brian Godman11Riphah Institute of Pharmaceutical Sciences, Riphah International University, Lahore 54000, PakistanDepartment of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, PakistanRiphah Institute of Pharmaceutical Sciences, Riphah International University, Lahore 54000, PakistanDepartment of Pharmacy Practice, College of Pharmacy, Qassim University, Buraydah 52571, Saudi ArabiaDepartment of Pharmacy Practice, College of Pharmacy, Qassim University, Buraydah 52571, Saudi ArabiaDepartment of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah 56215, Saudi ArabiaDepartment of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi ArabiaDepartment of Medical Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi ArabiaDepartment of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al Kharj 11942, Saudi ArabiaCenter of Health Systems and Safety Research, Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney 2109, AustraliaFaculty of Pharmacy, Hamdard University Islamabad Campus, Islamabad 700081, PakistanStrathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 0RE, UK<i>Background</i><b>:</b> There are concerns with inappropriate prescribing of antibiotics in hospitals especially broad spectrum in Pakistan and the subsequent impact on antimicrobial resistance rates. One recognized way to reduce inappropriate prescribing is for empiric therapy to be adjusted according to the result of culture sensitivity reports. <i>Objective:</i> Using culture sensitivity reports to optimize antibiotic prescribing in a teaching hospital in Pakistan. <i>Methods:</i> A retrospective observational study was undertaken in Ghurki Trust Teaching Hospital. A total of 465 positive cultures were taken from patients during the study period (May 2018 and December 2018). The results of pathogen identification and susceptibility testing from patient-infected sites were assessed. Additional data was collected from the patient’s medical file. This included demographic data, sample type, causative microbe, antimicrobial treatment, and whether empiric or definitive treatment as well as medicine costs. Antimicrobial data was assessed using World Health Organization’s Defined Daily Dose methodology. <i>Results:</i> A total of 497 isolates were detected from the 465 patient samples as 32 patients had polymicrobes, which included 309 g-negative rods and 188 g-positive cocci. Out of 497 isolates, the most common Gram-positive pathogen isolated was <i>Staphylococcus aureus</i> (Methicillin-sensitive <i>Staphylococcus aureus</i>) (125) (25.1%) and the most common Gram-negative pathogen was <i>Escherichia coli</i> (140) (28.1%). Most of the gram-negative isolates were found to be resistant to ampicillin and co-amoxiclav. Most of the <i>Acinetobacter baumannii</i> isolates were resistant to carbapenems. Gram-positive bacteria showed the maximum sensitivity to linezolid and vancomycin. The most widely used antibiotics for empiric therapy were cefoperazone plus sulbactam, ceftriaxone, amikacin, vancomycin, and metronidazole whereas high use of linezolid, clindamycin, meropenem, and piperacillin + tazobactam was seen in definitive treatment. Empiric therapy was adjusted in 220 (71.1%) cases of Gram-negative infections and 134 (71.2%) cases of Gram-positive infections. Compared with empiric therapy, there was a 13.8% reduction in the number of antibiotics in definitive treatment. The average cost of antibiotics in definitive treatment was less than seen with empiric treatment (8.2%) and the length of hospitalization also decreased. <i>Conclusions:</i> Culture sensitivity reports helped reduced antibiotic utilization and costs as well as helped select the most appropriate treatment. We also found an urgent need for implementing antimicrobial stewardship programs in hospitals and the development of hospital antibiotic guidelines to reduce unnecessary prescribing of broad-spectrum antibiotics.https://www.mdpi.com/1648-9144/59/7/1237anti-microbial resistanceanti-microbial stewardshipculture sensitivity reportscostsdefinitive treatmentempiric treatment |
| spellingShingle | Ummara Altaf Zikria Saleem Muhammad Furqan Akhtar Waleed Mohammad Altowayan Abdulmajeed A. Alqasoumi Mohammed Salem Alshammari Abdul Haseeb Fahad Raees Mohammad Tarique Imam Narjis Batool Muhammad Masoom Akhtar Brian Godman Using Culture Sensitivity Reports to Optimize Antimicrobial Therapy: Findings and Implications of Antimicrobial Stewardship Activity in a Hospital in Pakistan Medicina anti-microbial resistance anti-microbial stewardship culture sensitivity reports costs definitive treatment empiric treatment |
| title | Using Culture Sensitivity Reports to Optimize Antimicrobial Therapy: Findings and Implications of Antimicrobial Stewardship Activity in a Hospital in Pakistan |
| title_full | Using Culture Sensitivity Reports to Optimize Antimicrobial Therapy: Findings and Implications of Antimicrobial Stewardship Activity in a Hospital in Pakistan |
| title_fullStr | Using Culture Sensitivity Reports to Optimize Antimicrobial Therapy: Findings and Implications of Antimicrobial Stewardship Activity in a Hospital in Pakistan |
| title_full_unstemmed | Using Culture Sensitivity Reports to Optimize Antimicrobial Therapy: Findings and Implications of Antimicrobial Stewardship Activity in a Hospital in Pakistan |
| title_short | Using Culture Sensitivity Reports to Optimize Antimicrobial Therapy: Findings and Implications of Antimicrobial Stewardship Activity in a Hospital in Pakistan |
| title_sort | using culture sensitivity reports to optimize antimicrobial therapy findings and implications of antimicrobial stewardship activity in a hospital in pakistan |
| topic | anti-microbial resistance anti-microbial stewardship culture sensitivity reports costs definitive treatment empiric treatment |
| url | https://www.mdpi.com/1648-9144/59/7/1237 |
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