Antibiotic usage in community-acquired infections in hospitals in Taiwan.
OBJECTIVE
Using an epidemiologically meaningful in-hospital population with community-acquired infections, we evaluated antibiotic therapy in terms of indication and choice of antibiotic and microbiologic work-up.


METHODS
Infectious disease specialists evaluated charts of 436 patients from 9 hospitals and selected those who received antibiotics within 3 days of admission. Each antibiotic prescribed was marked for appropriateness of indication and choice. Microbiologic isolates were evaluated for their clinical significance.


RESULTS
The most common infections were in the lower respiratory tract (46.1%). Each patient received a mean of 2.25 antibiotics for 8.1 +/- 6.4 days. Of the 975 courses of antibiotics given in the study period, indication and choice were correct in 37.4% and unsatisfactory in 14.5%. The vast majority of antibiotics used (79.2%) were first-line antibiotics--usually first-generation cephalosporins, aminoglycosides, and aminopenicillins. Most patients (66%) had a microbiology laboratory work-up, but only 37.4% were judged by evaluators to have a meaningful microbiologic diagnosis. Among the 201 patients with lower respiratory tract infections, 105 (52.2%) had a diagnosis of pneumonia. A positive isolate was recovered in 30 (28.6%) patients, and most of these isolates (20, 68.7%) were aerobic gram-negative rods. There were three positive blood cultures but none grew Streptococcus pneumoniae.


CONCLUSIONS
Antibiotics were used excessively in number and duration. The microbiologic work-up had little effect on the indication and choice of antibiotics. Community-acquired pneumonia differed markedly from that in Western countries in that only 3.3% were caused by S. pneumoniae.
Ho
Monto
M
Division of Clinical Research, National Health Research Institutes, Memorial Hospital, 128 Yen-Chiu-Yuan Road, Section 2, Taipei, Taiwan.
Chang
Feng-Yee
FY
Yin
Hsiao-Chuan
HC
Ben
Ren-Jy
RJ
Chang
Luan-Yin
LY
Chen
Po-Yen
PY
Cheng
Shu-Hsing
SH
Chen
Shu-Ting
ST
Huang
Fang-Liang
FL
Lin
Hsiu-Chen
HC
Lu
Daniel C T
DC
Wang
Ning-Chi
NC
Wang
Jann-Tay
JT
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy*; D004363:Drug Utilization; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D013624:Taiwan
D000900:Anti-Bacterial Agents