Critical evaluation of antimicrobial use--a Turkish university hospital example.
BACKGROUND
Antimicrobials are being used unnecessarily for different reasons. The aims of this study were: assessment of the quality of antimicrobial use and determination of the factors related to correct use.


METHODS
Antimicrobial practice at Dicle University Hospital (DUH) was evaluated with a point prevalence approach. Using a standardized data collection form, the patients' data (clinic, epidemiology, laboratory and antimicrobial use) was collected. Possible influential factors on antimicrobial use were examined.


RESULTS
In the surveillance study 1,350 inpatients were evaluated; 461 (34.1%) of them were using antimicrobials for treatment and 187 (13.9%) for prophylaxis. Antimicrobial indication was found in 355 of 461 patients (77.0%), and the number of antimicrobials was 1.8 per patient in the treatment group. The most common reason for antimicrobial use was community-acquired infection (57.9%). Pneumonia (20.4%), skin and soft tissue infections (9.11%) and urinary tract infections (7.9%) were the most common infectious diseases. Positive culture results were available for 39 patients (8.5.0%) when antimicrobial treatment started. All steps of antimicrobial use were found appropriate in 243 patients (52.7%). In multivariate analyses, clinical manifestation of infection at the beginning (p <0.001), presence of leukocyte counting (p <0.001) and prescription by an infectious disease specialist were found significantly positive factors for wholly appropriate antimicrobial use. Hospitalization with a diagnosis other than infection was found a significantly negative factor for appropriate antimicrobial use (p=0.001).


CONCLUSIONS
The quality of antimicrobial use could be improved with better clinical and laboratory diagnosis and consultation with infectious diseases specialists.
Dicle University, School of Medicine, Diyarbakir, Turkey. hosoglu@hotmail.com.
Salih
S
Hosoglu
Zafer
Z
Parlak
Mehmet Faruk
MF
Geyik
Yilmaz
Y
Palanci
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D014421:Turkey; D055815:Young Adult
D000900:Anti-Bacterial Agents