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首页> 外文期刊>Infection and Drug Resistance >Rational use of antibiotics in an intensive care unit: a retrospective study of the impact on clinical outcomes and mortality rate
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Rational use of antibiotics in an intensive care unit: a retrospective study of the impact on clinical outcomes and mortality rate

机译：重症监护病房合理使用抗生素：对临床结局和死亡率影响的回顾性研究

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Background: Intensive care units (ICUs) are specialized units where patients with critical conditions are admitted for getting specialized and individualized medical treatment. High mortality rates have been observed in ICUs, but the exact reason and factors affecting the mortality rates have not yet been studied in the local population in Pakistan. Aim: This study was aimed to determine rational use of antibiotic therapy in ICU patients and its impact on clinical outcomes and mortality rate. Methods: This was a retrospective, longitudinal (cohort) study including 100 patients in the ICU of the largest tertiary care hospital of the capital city of Pakistan. Results: It was observed that empiric antibiotic therapy was initiated in 68% of patients, while culture sensitivity test was conducted for only 19% of patients. Thirty-percent of patients developed nosocomial infections and empiric antibiotic therapy was not initiated for those patients ( P 0.05). Irrational antibiotic prescribing was observed in 86% of patients, and among them, 96.5% mortality was observed ( P 0.05). The overall mortality rate was 83%; even higher mortality rates were observed in patients on a ventilator, patients with serious drug–drug interactions, and patients prescribed with irrational antibiotics or nephrotoxic drugs. Adverse clinical outcomes leading to death were observed to be significantly associated ( P 0.05) with irrational antibiotic prescribing, nonadjustment of doses of nephrotoxic drugs, use of steroids, and major drug–drug interactions. Conclusion: It was concluded that empiric antibiotic therapy is beneficial in patients and leads to a reduction in the mortality rate. Factors including irrational antibiotic selection, prescribing contraindicated drug combinations, and use of nephrotoxic drugs were associated with high mortality rate and poor clinical outcomes.
机译：背景：重症监护病房（ICUs）是专门病房，允许危重病患者接受专门的个性化治疗。在重症监护病房中已观察到高死亡率，但尚未对巴基斯坦当地人口研究影响死亡率的确切原因和因素。目的：本研究旨在确定ICU患者合理使用抗生素治疗及其对临床结果和死亡率的影响。方法：这是一项回顾性的纵向（队列）研究，包括巴基斯坦首都最大的三级医院的重症监护病房中的100名患者。结果：观察到68％的患者开始了经验性抗生素治疗，而仅19％的患者进行了培养敏感性试验。 30％的患者发生了医院感染，并且未为这些患者启动经验性抗生素治疗（P <0.05）。 86％的患者使用了不合理的抗生素处方，其中死亡率为96.5％（P <0.05）。总死亡率为83％;在呼吸机上，药物与药物相互作用严重的患者以及使用不合理抗生素或肾毒性药物的患者中观察到更高的死亡率。观察到导致死亡的不良临床结局与不合理的抗生素处方，肾毒性药物剂量的不调整，类固醇的使用以及主要的药物-药物相互作用显着相关（P <0.05）。结论：结论是经验性抗生素治疗对患者有益，并导致死亡率降低。包括抗生素选择不合理，处方禁忌药物组合以及使用肾毒性药物等因素与高死亡率和不良临床预后相关。

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