Özger Hasan Selçuk, Fakıoğlu Dolunay Merve, Erbay Kübra, Albayrak Aslınur, Hızel Kenan
Faculty of Medicine, Department of Infectious Diseases, Gazi University, Ankara, Turkey.
Faculty of Pharmacy, Department of Clinical Pharmacy, Gazi University, Ankara, Turkey.
BMC Infect Dis. 2020 Apr 19;20(1):289. doi: 10.1186/s12879-020-05005-7.
Gram-positive spectrum antibiotics such as vancomycin, teicoplanin, daptomycin, and linezolid are frequently used in empirical treatment combinations in critically ill patients. Such inappropriate and unnecessary widespread use, leads to sub-optimal utilisation. However they are covered by the antibiotics restriction programme. This prospective observational study, evaluates gram-positive anti-bacterial utilisations in intensive care units (ICUs) with various evaluation criteria, to determine the frequency of inappropriate usage and the intervention targets required to ensure optimum use.
This clinical study was conducted prospectively between 01.10.2018 and 01.10.2019 in the medical and surgical ICUs of Gazi University Faculty of Medicine Hospital, Turkey. The total bed capacity was 55. Patients older than 18 years and who were prescribed gram-positive spectrum antibiotics (vancomycin, teicoplanin, linezolid, and daptomycin) were included. Patients under this age or immunosuppressed patients (neutropenic,- HIV-infected patients with hematologic or solid organ malignancies) were not included in the study. During the study period, 200 treatments were evaluated in 169 patients. The demographic and clinical features of the patients were recorded. Besides observations by the clinical staff, the treatments were recorded and evaluated by two infectious diseases specialists and two clinical pharmacists at 24-h intervals from the first day to the last day of treatment. SPSS software for Windows, (version 17, IBM, Armonk, NY) was used to analyse the data. Categorical variables were presented as number and percentage, and non-categorical variables were presented as mean ± standard deviation.
It was found that inappropriate gram-positive antibiotic use in ICUs was as high as 83% in terms of non-compliance with the selected quality parameters. Multivariate analysis was performed to evaluate the factors associated with inappropriate antibiotic use, increased creatinine levels were found to increase the risk of such use.
In spite of the restricted antibiotics programme, inappropriate antibiotic use in ICUs is quite common. Thus, it is necessary to establish local guidelines in collaboration with different disciplines for the determination and follow-up of de-escalation of such use and optimal treatment doses.
万古霉素、替考拉宁、达托霉素和利奈唑胺等革兰氏阳性谱抗生素常用于重症患者的经验性治疗组合中。这种不恰当且不必要的广泛使用导致了抗生素的利用效果欠佳。然而，它们被纳入了抗生素限制计划。这项前瞻性观察性研究采用各种评估标准，对重症监护病房（ICU）中革兰氏阳性抗菌药物的使用情况进行评估，以确定不当使用的频率以及确保最佳使用所需的干预目标。
这项临床研究于2018年10月1日至2019年10月1日在土耳其加齐大学医学院医院的内科和外科ICU前瞻性地进行。总床位数为55张。纳入年龄大于18岁且开具了革兰氏阳性谱抗生素（万古霉素、替考拉宁、利奈唑胺和达托霉素）的患者。年龄小于该年龄的患者或免疫抑制患者（中性粒细胞减少症患者、感染HIV的血液系统或实体器官恶性肿瘤患者）不纳入本研究。在研究期间，对169例患者的200次治疗进行了评估。记录了患者的人口统计学和临床特征。除了临床工作人员的观察外，从治疗的第一天到最后一天，由两名传染病专家和两名临床药师每隔24小时对治疗进行记录和评估。使用Windows版SPSS软件（版本17，IBM，阿蒙克，纽约）分析数据。分类变量以数量和百分比表示，非分类变量以均值±标准差表示。
结果发现，就不符合选定的质量参数而言，ICU中革兰氏阳性抗生素的不当使用率高达83%。进行多变量分析以评估与不当抗生素使用相关的因素，发现肌酐水平升高会增加此类使用的风险。
尽管有抗生素限制计划，但ICU中不当使用抗生素的情况相当普遍。因此，有必要与不同学科合作制定当地指南，以确定和跟踪此类使用的降阶梯和最佳治疗剂量。
