title: Antibiotic prescription practices and their relationship to outcome in South Africa: findings of the prevalence of infection in South African intensive care units (PISA) study.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To document antibiotic prescription practices in public and private ICUs in South Africa and to determine their relationship to patient outcomes.
  
  
  METHODS
  A national database of public and private ICUs in South Africa was prospectively studied using a proportional probability sampling technique.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: Department of Anaesthesiology, University of the Witwatersrand, Johannesburg, South Africa. Fathima.Paruk@wits.ac.za
authors: Fathima
authors: F
authors: Paruk
authors: Guy
authors: G
authors: Richards
authors: Juan
authors: J
authors: Scribante
authors: Sats
authors: S
authors: Bhagwanjee
authors: Mervyn
authors: M
authors: Mer
authors: Helen
authors: H
authors: Perrie
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004352:Drug Resistance, Microbial; D019983:Guideline Adherence / Q000706:statistics & numerical data; D016304:Hospitals, Private / Q000458:organization & administration*; D006779:Hospitals, Public / Q000458:organization & administration; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents