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Original Article
Abstract
Background: It is widely acknowledged that the presence of infection is an important outcome
determinant for intensive care unit(ICU) patients. In fact, antibiotics are one of the most
common therapies administered in the ICU settings. Aim: To evaluate the current usage of
antibiotics in Latin American ICUs. Subjects and Methods: Aoneday point prevalence study
to investigate the patterns of antibiotic was undertaken in 72 Latin American(LA) ICUs. Data
was analyzed using the Statistix 8 statistical software, version 2.0 (USA). Results were expressed
as proportions. When applicable, two tailed hypothesis testing for difference in proportions was
used (Proportion Test); a P value of <0.05 was considered significant. Results: Of 704patients
admitted, 359 received antibiotic treatment on the day of the study(51%), of which 167/359
cases (46.5%) were due to hospitalacquired infections. The most frequent infection reorted
was nosocomial pneumonia(74/359, 21%). Only in 264/359 patients (73.5%), cultures before
starting antibiotic treatment were performed. Thirtyeight percent of the isolated microorganisms
were Enterobacteriaceae extendedspectrum lactamaseproducing, 11% methicillinresistant
Staphylococcusaureus and 10% carbapenemsresistant nonfermentative Gramnegatives.
The antibiotics most frequently prescribed were carbapenems(125/359, 35%), alone or in
combination with vancomycin or other antibiotic. There were no significant differences in
the restricted antibiotic prescription(carbapenems, vancomycin, piperacillintazobactam,
broadspectrum cephalosporins, fluoroquinolones, tigecycline and linezolid) between patients
with APACHE II score at the beginning of the antibiotic treatment<15[83/114(72.5%)]
and15[179/245(73%)](P=0.96). Only 29% of the antibiotic treatments were cultured
directed(104/359). Conclusion: Carbapenems(alone or in combination) were the most frequently
prescribed antibiotics in LA ICUs. However, the problem of carbapenem resistance in LA requires
that physicians improve the use of this class of antibiotics. Our findings show that our webbased
method for collection of oneday point prevalence was implemented successfully. However,
based on the limitations of the model used, the results of this study must be taken with caution.
Keywords: Antibiotics, Carbapenems, Intensive care unit, Usage
Introduction
It is widely acknowledged that the presence of infection
is an important outcome determinant for intensive care
unit(ICU) patients, mainly due to the extremely vulnerable
condition of critically ill patients and the high use of
DOI:
10.4103/2141-9248.113666
220
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Curcio, etal.: Antibiotics prescription in Latin American ICU
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Curcio, etal.: Antibiotics prescription in Latin American ICU
Results
General data
On the day of the prevalence study, there were 704patients
in the 72 participating ICUs(825 total beds), of whom
359(51%, range between ICUs 0 and 100%) were receiving
antibiotics[Table1].
There were 47/72(65%) ICUs in university hospitals and
25/72(35%) ICUs in nonuniversity hospitals. Most of the
participating ICUs had an ID specialist as a consultant to
assess the antibiotic precriptions [51/72(71%)]. Only 39/72
ICUs(54%) had an ongoing antimicrobial optimization
program at the moment of the study[Table1].
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Curcio, etal.: Antibiotics prescription in Latin American ICU
Value
Yes
No
Antimicrobial optimization program ongoing, n(%)
Yes
No
Number of patients admitted, n
Number of patients receiving antibiotics, n/total(%)
Age, mean years(range)
Male, n(%)
APACHE II, median, n(%)
15
<15
LOS3 between date of admission to the
diagnostic of infection, median(range)
Origin of the infection, n(%)
Nosocomial acquired
Community acquired
Type of infection, n(%)
Nosocomial pneumonia4
Communityacquired pneumonia
Intraabdominal infection
Genitourinay infection
Central nervous system infection
Skin and skin structures infection
Sepsis of unknown origin
Others
Cultures sites, n patients/total(%)
Cultures sites, n samples/n per patient
Blood cultures, n/total(%)
Respiratory samples5, n/total(%)
Urine culture, n/total(%)
Peritoneal fluid, n/total(%)
Skin and soft tissue, n/total(%)
Others
Positives cultures
n positive cultures/n total cultures(%)
Clinical isolates
n isolates/n total positive cultures
ESBL6producing Enterobacteriaceae, n/total(%)
Pseudomonas aeruginosa, n/total(%)
carbR7P.aeruginosa, n/total(%)
carbS8P.aeruginosa, n/total(%)
Acinetobacter spp.
carbR7Acinetobacter spp.
carbS8Acinetobacter spp.
Staphylococcusaureus
MRSA9
Others
72
47(65)
25(35)
51(71)
21(29)
39(54)
33(46)
704
359/704(51)
57.8(18-95)
186(52)
18
245(68)
114(32)
11(0-34)
167(46.5)
192(53.5)
74(21)
53(15)
44(12)
44(12)
24(6.7)
24(6.7)
24(6.7)
73(19.9)
264/359(73.5)
378/1.43
140/378(37)
124/378(33)
49/378(13)
28/378(7.4)
22/378(5.8)
15/378(3.8)
196/378(52)
277/196
106/277(38)
48/277(17)
20/48(41.5)
28/48(58.5)
42/277(15)
16/42(38)
26/42(62)
30/277(11)
17/30(57)
51/277(19)
n/n total(%)
128/206(62)
109/206(53)
68/206(33)
14/206(6.8)
9/206(4.3)
7/206(3.4)
5/206(2.4)
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Curcio, etal.: Antibiotics prescription in Latin American ICU
Discussion
Value
181(50.5)
104(29)
64(18)
10(2.5)
181(50)
129/181(71)
52/181(29)
54/181(30)
44/181(24.5)
36/181(20)
36/181(20)
25/181(14)
65/181(36)
359/703(51)
125/359(35)
91/359(25)
81/359(22.5)
66/359(18)
43/359(12)
40/359(11)
38/359(10.5)
83/359(23)
APACHE II3
15 (n=245) <15 (n=114)
179(73)
83(72.5)
66(27)
31(27.5)
P=0.96
Type of hospital
University (n=47) Nonuniversity (n=25)
39(82.5)
19(75)
8(17.5)
6(25)
P=0.07
ID specialist4
Yes(n=51) No(n=21)
38(75)
17(79)
13(25)
4(21)
P=0.34
AOP5 ongoing
Yes(n=39) No(n=33)
31(80)
25(76)
9(20)
8(25)
P=0.60
*Carbapenems, vancomycin, piperacillin-tazobactam, broadspectrum cephalosporins, fluoroquinolones, tigecycline and linezolid, 1Patients who received restricted antibiotics, 2Patients
who did not receive restricted antibiotics, 3At admission, 4Infectious diseases specialist as consultant in the intensive care unit, 5Antibiotic optimization program
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Curcio, etal.: Antibiotics prescription in Latin American ICU
Acknowledgment
Appendix
List of the Authors
Latin American Antibiotic Use in Intensive Care Unit Group:
Cueto DA1, Baales Churrut A2; Bello Alvarez L3; Belloni R45
; Bolona E6; Caballero Narvez H7; Camacho Alarcn R8-9,
Caarte Bermudez G10, Carreo Rodriguez JN11; Carvajal
Herrera M12, Castagnino J13, Castillo Bravo L14, Chung Sang
Wong M15 Duarte DA16; Escalante-Kanashiro L17; Valerio Rojas
JC18, Fang Li JA19; Fernndez Mercado J20-21, Ferreira Cabrera
L22, Figueroa Cornejo V23; Alonso Fuentes Lugo E24; Gonzalez
LD25; Guerrero F26; Ibez-Guzmn C27, Intriago Cedeo V28,
Bermudez Zambrano L28; Jtiva M29, Narvaez LJ30; La Fuente
Zerain G31, Labarca E32, Marn Torres G33; Mendoza Franco
R34, Messino Julio A35; Molina Saldarriaga F36; Montufar
Andrade FE37-39; Morales Alava F40, Morales Inzunza RA41;
Olivares G42, Carmargo R42, Oyanguren M43, Paz E44; Prez
F45, Portugal J43; Quispe Sierra R46; Ovalle Olmos R46, Ramos
Palomino I47, Ranero Meneses J48, Rebolledo Maldonado
C49, Rey Saavedra JA50; Rojas Vera JE51; Rojas-Suarez J21,
Romero V52, Ruiz Oliveros N53, Salas Villasante J54, Salgado
Yepez ER55; Salva Sutherland S56, Soto Germani L57, Thomen
Palacio RE58; Tobar E59; Urbina Contreras Z60, Valencia E61,
Varnava C62; Vega S63; Vergara Centeno J64, Villalobos Vindas
J65, Villlalobos Galban G66; Yepes D67, Zetina Muoz R68,
Curiale A69, Tcach A69
Affliliations
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Curcio, etal.: Antibiotics prescription in Latin American ICU
References
1.
2.
3.
5.
6.
7.
8.
9.
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Curcio, etal.: Antibiotics prescription in Latin American ICU
31. Tognim MC, Andrade SS, Silbert S, Gales AC, Jones RN,
SaderHS. Resistance trends of Acinetobacter spp. In Latin
America and characterization of international dissemination
of multidrug resistant strains: Fiveyear report of the
SENTRY antimicrobial surveillance program. Int J Infect Dis
2004;8:28491.
228
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