Antibiotic treatment and clinical characteristics in an intensive care unit

Abstract

Abstract Degree Project, Programme in Medicine Antibiotic treatment and clinical characteristics in an intensive care unit – a retrospective study at Tribhuvan University Teaching Hospital, Kathmandu, Nepal Theresia Fridh, 2015 Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Supervisors: Göran Kurlberg, PhD. Department of Surgery, Sahlgrenska University Hopsital, Gothenburg, Sweden. Yogendra P Singh, PhD and Bikal Ghimire, MD. Department of Surgery, Tribhuvan Univeristy Teaching Hospital, Kathmandu, Nepal Introduction Sepsis is a serious complication in surgical patients. Blood culture is a cornerstone in the treatment with antibiotics to facilitate the correct choice of drug and descaling empirical treatment. The descaling of antibiotic treatment is in turn an important part of slowing down antibiotic resistance, a growing problem around the world. Aim To describe the demographics and clinical characteristics of gastrointestinal surgical patients being treated in a Nepalese ICU during hospital stay; also to describe the use of antibiotics in these patients and how guidelines are followed. A secondary aim was focused on blood cultures in these patients; frequency and resistance patterns. Method Medical records from 50 patients with gastrointestinal surgical conditions being treated in the ICU during one year could be relocated and were reviewed. Results All patients received antibiotic treatment during hospital stay with the mean number of antibiotic courses being 4.8 and cephalosporins being the most commonly used group. A higher number of treatments was associated with increased mortality (p = 0.171). Blood culture was obtained from 42 % (n = 21) of patients. 81 % of the patients had received antibiotics prior to sampling for blood culture. Five cultures were positive and four out of five showed multidrug resistance. The median length of stay in hospital was longer for the group with positive cultures but the difference was not significant. Conclusions This study indicates that an extensive use of a number of antibiotics do not improve survivial. The importance of following guidelines such as “Surviving Sepsis Campaign” is amplified. Blood cultures should be obtained more frequently to focus the use of antibiotics accordingly and thereby lower morbidity and mortality. Antibiotic resistance is highly present in this setting but more extensive studies are warranted to draw further attention to the issue.