科研之友
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摘要
Background and objective: Irrational use of broad-spectrum antibiotics has contributed to the emergence and spread of resistant strains of microorganisms, increased the costs of treatment, morbidity and mortality, drug toxicity and long hospitalization. The problem is particularly important in developing countries where more discrepancies have been reported. The objective of this study was to evaluate the use of Piperacillin/Tazobatam (PIP/TAZ) in hospitalized patients in order to identify degree of compliance to the criteria approved by antibiotic subcommittee of the hospital.
Methods: Study was conducted in Aga Khan University Hospital, Karachi, Pakistan: a 543-bed university teaching hospital. Two hundreds patients who received PIP/TAZ during the period from 15(th) April 2008 to 31(st) July 2008 were included. Use of PIP/TAZ was evaluated against approved criteria regarding indication appropriateness, duration of therapy and other process indicators. Degree of compliance to the-approved criteria was determined in different clinical departments and areas with statistically significant noncompliance were identified.
Results: In total of 200 cases, PIP/TAZ was found to be indicated appropriately in 147 cases (73.5%) while it was indicated inappropriately in 53 cases (26.5 %; p <0.001); noncompliance was significant in obstetrics/gynecology (p <0.001), surgery (p <0.001), neurology (p <0.01) and medicine (p <0.001). Cultures prior to therapy were obtained in 164 cases (82% of total 200 cases) while it was missing in 36 cases (18%; p <0.001); noncompliance was significant in obstetrics/gynecology (p <0.001) and surgery (p <0.001). Duration of therapy was found to be appropriate in 85 cases (58% of 147 cases) while inappropriateness was recorded in 62 cases (42%; p <0.001); noncompliance was significant in pediatrics (p <0.001), oncology (p <0.001), medicine (p <0.001), surgery (p <0.001) and ICU (p <0.001). In case of other process indicators, satisfactory consistency was recorded in all departments except in obstetrics/gynecology where noncompliance was significant in obtaining pretreatment creatinine (p <0.001) and pretreatment total leucocyte & neutrophil count (p <0.01).
Conclusion: Considerable discrepancies were identified in case of duration of therapy, indication appropriateness, obtaining pretreatment culture and in few instances in other process indicators. These problems may be addressed in the development of strategies to rationalize the use of PIP/TAZ.
- 出版日期2010
