Adequacy of empirical antibiotic for patient admitted to ICU with sepsis

Objectives: Sepsis is one of the commonest causes of ICU which lead to high mortality and morbidity. Early empirical antibiotic treatment is important to improve the patient's outcome . The aim of this study was to assess the adequacy of empirical antibiotic therapy for sepsis patients in In...

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Main Author:	Hashim, Halimatul Nadia M
Format:	Thesis
Language:	English
Published:	2016
Subjects:	RA643-645 Disease (Communicable and noninfectious) and public health
Online Access:	http://eprints.usm.my/41896/1/Dr._Halimatul_Nadia_M._Hashim-24_pages.pdf
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spelling	my-usm-ep.418962019-04-12T05:25:28Z Adequacy of empirical antibiotic for patient admitted to ICU with sepsis 2016 Hashim, Halimatul Nadia M RA643-645 Disease (Communicable and noninfectious) and public health Objectives: Sepsis is one of the commonest causes of ICU which lead to high mortality and morbidity. Early empirical antibiotic treatment is important to improve the patient's outcome . The aim of this study was to assess the adequacy of empirical antibiotic therapy for sepsis patients in Intensive Care Unit (ICU), Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu. Methods: This was a retrospective, observational study to evaluate the adequacy of empirical antibiotic given to patients who were diagnosed with sepsis in ICU. 130 cases who were admitted to ICU for sepsis from January 2013 to December 2013 were selected and their medical record were traced from HIS (Hospital Information System) and reviewed. Their demographic profiles, underlying comorbidities, antibiotic usage, culture and sensitivity results as well as patient’s outcome were reviewed. The adequacy of empirical treatment in each case was determined. Adequate empirical antibiotic treatment was considered adequate if spectrum, dose, application modus, and duration of therapy were appropriate according to MSIC (Malaysian Society of Intensive Care) guidelines. Results: Among 130 intensive care unit patients with sepsis, 119 (91.5%) received adequate antimicrobial treatment. In this group, the mean age of patients was 51.8 year old and 51.3% of them were men.112 (86.2%) patients presented with septic shock and 104 (87.4%) of them were given adequate empirical antibiotic. The main sources of bacteremia in this group were from lungs (42%), abdomen (21%) or skin and soft tissue (15.1%). The microorganisms most frequently isolated were Escherichia coli 13 (37.1%), Burkholderia pseudomallei 7 (20.0%), followed with Klebsiella pneumonia 6 (17.1%), Acinobacter baumanii 4 (11.4%) and Leptospira interrogan 2 (5.7%). For patients with gram positive culture, which affected 25 patients with adequate treatment, coagulase negative staphylococcus, 11 (44.0%), and staphylococcus aureus, 11 (44.0%), were the most common organisms. This was followed with streptococcus pneumonia in 3 (12.0%) patients. Among the adequate group of patients, cephalosporin was the most frequently used, 63 (52.9%), carbapenem in 21 (17.6%) patients became the second option followed with Piperacillin/tazobactam in 17 (14.3%) patients and Amoxycillin / clavulanic acid 6 (5.0%). Comparing both group of patients who received adequate and inadequate empirical antibiotics therapy, the outcome were not statistically significant in terms of the duration of ventilation and ICU stay, duration of hospitalization as well as patient mortality and survival. However there was 10% reduction of mortality in adequate treatment group 2016 Thesis http://eprints.usm.my/41896/ http://eprints.usm.my/41896/1/Dr._Halimatul_Nadia_M._Hashim-24_pages.pdf application/pdf en public masters Universiti Sains Malaysia Pusat Pengajian Sains Perubatan
institution	Universiti Sains Malaysia
collection	USM Institutional Repository
language	English
topic	RA643-645 Disease (Communicable and noninfectious) and public health
spellingShingle	RA643-645 Disease (Communicable and noninfectious) and public health Hashim, Halimatul Nadia M Adequacy of empirical antibiotic for patient admitted to ICU with sepsis
description	Objectives: Sepsis is one of the commonest causes of ICU which lead to high mortality and morbidity. Early empirical antibiotic treatment is important to improve the patient's outcome . The aim of this study was to assess the adequacy of empirical antibiotic therapy for sepsis patients in Intensive Care Unit (ICU), Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu. Methods: This was a retrospective, observational study to evaluate the adequacy of empirical antibiotic given to patients who were diagnosed with sepsis in ICU. 130 cases who were admitted to ICU for sepsis from January 2013 to December 2013 were selected and their medical record were traced from HIS (Hospital Information System) and reviewed. Their demographic profiles, underlying comorbidities, antibiotic usage, culture and sensitivity results as well as patient’s outcome were reviewed. The adequacy of empirical treatment in each case was determined. Adequate empirical antibiotic treatment was considered adequate if spectrum, dose, application modus, and duration of therapy were appropriate according to MSIC (Malaysian Society of Intensive Care) guidelines. Results: Among 130 intensive care unit patients with sepsis, 119 (91.5%) received adequate antimicrobial treatment. In this group, the mean age of patients was 51.8 year old and 51.3% of them were men.112 (86.2%) patients presented with septic shock and 104 (87.4%) of them were given adequate empirical antibiotic. The main sources of bacteremia in this group were from lungs (42%), abdomen (21%) or skin and soft tissue (15.1%). The microorganisms most frequently isolated were Escherichia coli 13 (37.1%), Burkholderia pseudomallei 7 (20.0%), followed with Klebsiella pneumonia 6 (17.1%), Acinobacter baumanii 4 (11.4%) and Leptospira interrogan 2 (5.7%). For patients with gram positive culture, which affected 25 patients with adequate treatment, coagulase negative staphylococcus, 11 (44.0%), and staphylococcus aureus, 11 (44.0%), were the most common organisms. This was followed with streptococcus pneumonia in 3 (12.0%) patients. Among the adequate group of patients, cephalosporin was the most frequently used, 63 (52.9%), carbapenem in 21 (17.6%) patients became the second option followed with Piperacillin/tazobactam in 17 (14.3%) patients and Amoxycillin / clavulanic acid 6 (5.0%). Comparing both group of patients who received adequate and inadequate empirical antibiotics therapy, the outcome were not statistically significant in terms of the duration of ventilation and ICU stay, duration of hospitalization as well as patient mortality and survival. However there was 10% reduction of mortality in adequate treatment group
format	Thesis
qualification_level	Master's degree
author	Hashim, Halimatul Nadia M
author_facet	Hashim, Halimatul Nadia M
author_sort	Hashim, Halimatul Nadia M
title	Adequacy of empirical antibiotic for patient admitted to ICU with sepsis
title_short	Adequacy of empirical antibiotic for patient admitted to ICU with sepsis
title_full	Adequacy of empirical antibiotic for patient admitted to ICU with sepsis
title_fullStr	Adequacy of empirical antibiotic for patient admitted to ICU with sepsis
title_full_unstemmed	Adequacy of empirical antibiotic for patient admitted to ICU with sepsis
title_sort	adequacy of empirical antibiotic for patient admitted to icu with sepsis
granting_institution	Universiti Sains Malaysia
granting_department	Pusat Pengajian Sains Perubatan
publishDate	2016
url	http://eprints.usm.my/41896/1/Dr._Halimatul_Nadia_M._Hashim-24_pages.pdf
_version_	1747820991205081088

Adequacy of empirical antibiotic for patient admitted to ICU with sepsis

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