title: Antibiotic prescriptions in critically-ill patients: a latin american experience.
abstract: BACKGROUND
  It is widely acknowledged that the presence of infection is an important outcome determinant for intensive care unit (ICU) patients. In fact, antibiotics are one of the most common therapies administered in the ICU settings.
  
  
  OBJECTIVE
  To evaluate the current usage of antibiotics in Latin American ICUs.
  
  
  METHODS
  A one-day p-oint prevalence study to investigate the patterns of antibiotic was undertaken in 72 Latin American (LA) ICUs. Data was analyzed using the Statistix 8 statistical software, version 2.0 (USA). Results were expressed as proportions. When applicable, two tailed hypothesis testing for difference in proportions was used (Proportion Test); a P value of <0.05 was considered significant.
  
  
  RESULTS
  Of 704 patients admitted, 359 received antibiotic treatment on the day of the study (51%), of which 167/359 cases (46.5%) were due to hospital-acquired infections. The most frequent infection reorted was nosocomial pneumonia (74/359, 21%). Only in 264/359 patients (73.5%), cultures before starting antibiotic treatment were performed. Thirty-eight percent of the isolated microorganisms were Enterobacteriaceae extended-spectrum β-lactamase-producing, 11% methicillin-resistant Staphylococcus aureus and 10% carbapenems-resistant non-fermentative Gram-negatives. The antibiotics most frequently prescribed were carbapenems (125/359, 35%), alone or in combination with vancomycin or other antibiotic. There were no significant differences in the "restricted" antibiotic prescription (carbapenems, vancomycin, piperacillin-tazobactam, broad-spectrum cephalosporins, fluoroquinolones, tigecycline and linezolid) between patients with APACHE II score at the beginning of the antibiotic treatment <15 [83/114 (72.5%)] and ≥15 [179/245 (73%)] (P = 0.96). Only 29% of the antibiotic treatments were cultured directed (104/359).
  
  
  CONCLUSIONS
  Carbapenems (alone or in combination) were the most frequently prescribed antibiotics in LA ICUs. However, the problem of carbapenem resistance in LA requires that physicians improve the use of this class of antibiotics. Our findings show that our web-based method for collection of one-day point prevalence was implemented successfully. However, based on the limitations of the model used, the results of this study must be taken with caution.
authors.affiliation: Instituto Sacre Couer and Hospital Municipal Chivilcoy, Argentina.
authors.forename: D
authors.initials: D
authors.lastname: Curcio
keywords: Antibiotics; Carbapenems; Intensive care unit; Usage
references.citation: Lancet Infect Dis. 2010 Sep;10(9):597-602
references.pmid: 20705517
references.citation: Int J Infect Dis. 2004 Sep;8(5):284-91
references.pmid: 15325597
references.citation: Emerg Infect Dis. 2007 Aug;13(8):1144-9
references.pmid: 17953083
references.citation: Clin Infect Dis. 2009 Nov 15;49(10):1496-504
references.pmid: 19842976
references.citation: Scand J Infect Dis. 2007;39(1):63-9
references.pmid: 17366015
references.citation: Clin Chest Med. 2011 Sep;32(3):517-34
references.pmid: 21867820
references.citation: Antimicrob Agents Chemother. 2010 Jan;54(1):109-15
references.pmid: 19841152
references.citation: Arch Intern Med. 2005 Jun 27;165(12):1375-80
references.pmid: 15983286
references.citation: Braz J Infect Dis. 2011 Jul-Aug;15(4):370-6
references.pmid: 21861009
references.citation: Braz J Infect Dis. 2011 Jan-Feb;15(1):69-73
references.pmid: 21412593
references.citation: J Infect. 1997 Nov;35(3):283-8
references.pmid: 9459403
references.citation: AORN J. 2011 Jul;94(1):27-36
references.pmid: 21722769
references.citation: Int J Antimicrob Agents. 2004 Apr;23(4):325-31
references.pmid: 15081079
references.citation: J Infect Dis. 2008 Apr 15;197(8):1079-81
references.pmid: 18419525
references.citation: Infect Control Hosp Epidemiol. 2008 Jul;29(7):615-22
references.pmid: 18624668
references.citation: J Antimicrob Chemother. 2008 Feb;61(2):436-41
references.pmid: 18056733
references.citation: J Chemother. 2009 Nov;21(5):527-34
references.pmid: 19933044
references.citation: Am J Infect Control. 2008 May;36(4):283-90
references.pmid: 18455049
references.citation: Am J Respir Crit Care Med. 1997 Jul;156(1):196-200
references.pmid: 9230747
references.citation: J Chemother. 2005 Feb;17(1):74-6
references.pmid: 15828447
references.citation: Clin Microbiol Infect. 2011 Oct;17(10):1520-4
references.pmid: 21851480
references.citation: Antimicrob Agents Chemother. 2011 Nov;55(11):5350-3
references.pmid: 21844315
references.citation: Intensive Care Med. 2005 Jul;31(7):927-33
references.pmid: 15856171
references.citation: Crit Care Clin. 2011 Jan;27(1):35-51
references.pmid: 21144985
references.citation: Arch Intern Med. 2011 Aug 8;171(15):1322-31
references.pmid: 21824946
references.citation: Eur Respir J. 2006 Jan;27(1):158-64
references.pmid: 16387949
references.citation: Clin Infect Dis. 2005 Sep 1;41 Suppl 5:S354-67
references.pmid: 16080073
references.citation: Braz J Infect Dis. 2004 Feb;8(1):25-79
references.pmid: 15286878
references.citation: Diagn Microbiol Infect Dis. 2011 Sep;71(1):38-45
references.pmid: 21763093
references.citation: Infect Control Hosp Epidemiol. 2007 Dec;28(12):1389-95
references.pmid: 17994520
references.citation: Clin Infect Dis. 1999 Aug;29(2):245-52
references.pmid: 10476720
references.citation: J Hosp Infect. 2010 May;75(1):23-7
references.pmid: 20338669
references.citation: BMC Infect Dis. 2011 Nov 01;11:303
references.pmid: 22044716