Department of Anaesthesiology, University of the Witwatersrand, Johannesburg, South Africa.
S Afr Med J. 2012 Jun 14;102(7):613-6. doi: 10.7196/samj.5833.
The emergence of multidrug-resistant, extensively resistant and pan-resistant pathogens and the widespread inappropriate use of antibiotics is a global catastrophe receiving increasing attention by health care authorities. The antibiotic prescription practices in public and private intensive care units (ICUs) in South Africa are unknown.
To document antibiotic prescription practices in public and private ICUs in South Africa and to determine their relationship to patient outcomes.
A national database of public and private ICUs in South Africa was prospectively studied using a proportional probability sampling technique.
Two hundred and forty-eight patients were recruited. Therapeutic antibiotics were initiated in 182 (73.5%), and 54.9% received an inappropriate antibiotic initially. De-escalation was practised in 33.3% and 19.7% of the public and private sector patients, respectively. Antibiotic duration was inappropriate in most cases. An appropriate choice of antibiotic was associated with an 11% mortality, while an inappropriate choice was associated with a 27% mortality (p=0.01). The mortality associated with appropriate or inappropriate duration of antibiotics was 17.6% and 20.6%, respectively (p=0.42).
Inappropriate antibiotic prescription practices in ICUs in the public and private sectors in South Africa are common and are also associated with poor patient outcomes.
多药耐药、广泛耐药和全耐药病原体的出现以及抗生素的广泛不当使用是一个全球灾难，越来越受到卫生当局的关注。南非公立和私立重症监护病房（ICU）的抗生素处方实践情况尚不清楚。
记录南非公立和私立 ICU 的抗生素处方实践情况，并确定其与患者结局的关系。
采用比例概率抽样技术对南非公立和私立 ICU 进行了全国性的数据库前瞻性研究。
共招募了 248 名患者。182 名（73.5%）开始使用治疗性抗生素，其中 54.9%最初使用了不适当的抗生素。分别有 33.3%和 19.7%的公立和私立部门患者进行了降级治疗。大多数情况下，抗生素持续时间都不适当。抗生素选择适当与 11%的死亡率相关，而选择不当时与 27%的死亡率相关（p=0.01）。抗生素使用时间适当或不当时的死亡率分别为 17.6%和 20.6%（p=0.42）。
南非公立和私立部门 ICU 中抗生素处方实践不当的情况很常见，并且与患者预后不良有关。
