Phân tích tình hình sử dụng kháng sinh trên bệnh nhân viêm phổi bệnh viện/ viêm phổi thở máy điều trị tại Khoa Hồi sức tích cực, Bệnh viện Đa khoa Thành phố Cần Thơ

Abstract

The use of antibiotics for treatment of hospital- and ventilator-acquired pneumonia in the Intensive Care Unit (ICU) of Can Tho General Hospital was investigated by prospective observation on the patients with diagnosis of pneumonia at least 48 hours after ICU admission in the period of 11/2017 - 02/2018. The appropriateness of prescribing of empirical antibiotics were microbiologically evaluated. Besides, the rationality of empirical regimens and pathogen-specific therapies was assessed in observance of IDSA/ATS guidelines for HAP/VAP 2016. The study involved 57 patients with pneumonia (the patients with less than 5 days of hospitalization were excluded). Of them, 08 (14.5%) received appropriate empirical therapy with regard to the pathogen identification. Meanswhile, A. baumannii isolation proved the inappropriate empirical therapy showed an increasing tendency (OR 4.82 - 95%; Cl: 0.95 - 24.32) (statistically unsignificant, p = 0.089). In reference to the guidance of IDSA/ATS (2016), 87.3% of empirical therapies and 71.1% of pathogen-specific regimens appeared inappropriate. The most commonly prescribed antibiotics in ICU were carbapenems, to 84.2% of patients. However, the recommendation of prolonged infusion of carbapenems was rather seldom observed (22.0% with imipenem and 26.7% with meropenem). Colistin was prescribed to 35.1% of patients and mostly found in alternative regimens (95%). In conclusion, these findings suggested that empirical antibiotics should target to A. baumannii and the antibiotic dose should be optimized by PKJPD consideration.