Evaluating the frequency of antibiotic consumption in a PICU of a tertiary care hospital in Karachi: A Prospective study
DOI:
https://doi.org/10.61529/idjp.v35i2.430Abstract
Background: Antibiotics have transformed the medical field; however, the increase in antimicrobial resistance (AMR) threatens their effectiveness, particularly in Pediatric Intensive Care Units (PICUs), where critically ill children are highly vulnerable to infections.
Material and Methods: A prospective observational study was conducted in the PICU of a tertiary-care hospital in Karachi, Pakistan, from 1st June 2023 to 31st May 2024. All critically ill children (1 month to 15 years) admitted in the PICU, regardless of the antibiotic exposure were included, excluding immunocompromised children or those who were discharged before 72 hours. Antibiotics were categorized as empirical, therapeutic, or prophylactic. Empirical antibiotics outcomes after 72 hours were classified as "remains unchanged," "discontinued," "changed," or "continued as therapeutics".
Results: Of 265 admissions, 257 (97%) received antibiotics, predominantly Empirical (89.1%). On the first day, 59.1% received monotherapy, primarily Ceftriaxone (57.9%); whereas 39.3% received dual-therapy, most often Meropenem-Vancomycin (37.6%). After 72 hours, empirical therapy remained unchanged in 63% of cases, changed in 15.6%, discontinued in 16.2%, and continued as therapeutic in 5.2%. The median duration of antibiotic therapy was 5 days (IQR: 4-8). The total multidrug-resistance organism (MDRO) rate was 7.6% and mortality rate was 6.6%.
Conclusion: Antibiotics use in the PICU was extensive and predominantly empirical, with limited reassessment after initiation. These findings highlight the importance to strengthen antimicrobial stewardship practices, optimize antibiotic utilization, and mitigate the emergence of AMR in PICU.
Keywords: Antibiotic Stewardship, Empirical Therapy, LMICs, PICU.
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