Department of Anaesthesia and Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi.
College of Medicine, University of Malawi, Blantyre, Malawi.
BMC Infect Dis. 2020 Oct 19;20(1):776. doi: 10.1186/s12879-020-05505-6.
Antibiotic resistance is on the rise. A contributing factor to antibiotic resistance is the misuse of antibiotics in hospitals. The current use of antibiotics in ICUs in Malawi is not well documented and there are no national guidelines for the use of antibiotics in ICUs. The aim of the study was to describe the use of antibiotics in a Malawian ICU.
A retrospective review of medical records of all admissions to the main ICU in Queen Elizabeth Central Hospital in Blantyre, Malawi, between January 2017 and April 2019. Data were extracted from the ICU patient register on clinical parameters on admission, diagnoses, demographics and antibiotics both prescribed and given for all patients admitted to the ICU. Usage of antibiotics in the ICU and bacterial culture results from samples taken in the ICU and in the peri-ICU period, (from 5 days before ICU admission to 5 days after ICU discharge), were described.
Six hundred-and-forty patients had data available on prescribed and received medications and were included in the analyses. Of these, 577 (90.2%) were prescribed, and 522 (81.6%) received an antibiotic in ICU. The most commonly used antibiotics were ceftriaxone, given to 470 (73.4%) of the patients and metronidazole to 354 (55.3%). Three-hundred-and-thirty-three (52.0%) of the patients received more than one type of antibiotic concurrently - ceftriaxone and metronidazole was the most common combination, given to 317 patients. Forty five patients (7.0%) were given different antibiotics sequentially. One-hundred-and-thirty-seven patients (21.4%) had a blood culture done in the peri-ICU period, of which 70 (11.0% of the patients) were done in the ICU. Twenty-five (18.3%) of the peri-ICU cultures were positive and eleven different types of bacteria were grown in the cultures, of which 17.2% were sensitive to ceftriaxone.
We have found a substantial usage of antibiotics in an ICU in Malawi. Ceftriaxone, the last-line antibiotic in the national treatment guidelines, is commonly used, and bacteria appear to show high levels of resistance to it, although blood culture testing is infrequently used. Structured antibiotic stewardship programs may be useful in all ICUs.
抗生素耐药性正在上升。抗生素耐药性的一个促成因素是医院对抗生素的滥用。目前，马拉维重症监护病房（ICU）中抗生素的使用情况没有得到很好的记录，也没有关于 ICU 中抗生素使用的国家指南。本研究的目的是描述马拉维 ICU 中抗生素的使用情况。
对 2017 年 1 月至 2019 年 4 月期间在马拉维布兰太尔伊丽莎白女王中央医院主要 ICU 住院的所有患者的病历进行回顾性审查。从 ICU 患者登记册中提取入院时的临床参数、诊断、人口统计学和所有 ICU 入院患者的处方和使用抗生素的数据。描述 ICU 中抗生素的使用情况以及 ICU 内和 ICU 周边期间（从 ICU 入院前 5 天到 ICU 出院后 5 天）采集的样本的细菌培养结果。
640 名患者有处方和使用药物的数据，纳入分析。其中，577 名（90.2%）患者接受了抗生素治疗，522 名（81.6%）患者在 ICU 中接受了抗生素治疗。使用最广泛的抗生素是头孢曲松，470 名（73.4%）患者使用了头孢曲松，354 名（55.3%）患者使用了甲硝唑。333 名（52.0%）患者同时使用了不止一种类型的抗生素-头孢曲松和甲硝唑是最常见的联合用药，有 317 名患者使用。45 名（7.0%）患者先后使用了不同的抗生素。137 名（21.4%）患者在 ICU 周边期间进行了血培养，其中 70 名（11.0%的患者）在 ICU 中进行了血培养。25 份（18.3%）ICU 周边培养物呈阳性，培养出 11 种不同类型的细菌，其中 17.2%对头孢曲松敏感。
我们发现马拉维 ICU 中抗生素的使用量很大。国家治疗指南中的最后一线抗生素头孢曲松的使用非常普遍，而且细菌对其似乎表现出很高的耐药性，尽管血液培养检测的使用频率很低。在所有 ICU 中，抗生素管理计划可能都很有用。
