Abstract：
Guidelines for the selection of empirical antibiotics have been developed to improve patient outcomes and reduce unnecessary antibiotic use. We assessed the extent of adherence to the national guidelines for the selection of parenteral empirical antibiotics for three selected infections at a tertiary care center.
A prospective cross-sectional study was conducted in medical and surgical wards of a tertiary care hospital in Sri Lanka. Adult patients with a positive culture for a lower respiratory tract infection (LRTI), skin and soft tissue infection (SSTI), or urinary tract infection (UTI) and who were prescribed parenteral empirical antibiotic therapy by the attending physician were included. Bacteria were identified and antibiotic susceptibility was determined by standard microbiological methods. Adherence to the guidelines was defined as prescribing the empiric antibiotic concordant with the national guidelines on the empirical use of antibiotics.
A total of 160 bacterial isolates were obtained from 158 patients with positive cultures, the majority were from UTIs (n = 56). The selection of empirical antibiotics was concordant with the national guidelines in 92.4% of patients and 29.5% of the bacterial isolates obtained from these patients were resistant to the prescribed empiric antibiotic. Only 47.5% (76/160) of the bacterial isolates were sensitive to the empiric antibiotic and therefore can be considered an appropriate antibiotic prescription.
Empirical antibiotic guidelines should be updated based on the latest surveillance data and information on prevailing bacterial spectra. Antibiotic prescribing patterns and guideline concordance should be periodically evaluated to ensure whether antimicrobial stewardship programs are moving in the right direction.
A prospective cross-sectional study was conducted in medical and surgical wards of a tertiary care hospital in Sri Lanka. Adult patients with a positive culture for a lower respiratory tract infection (LRTI), skin and soft tissue infection (SSTI), or urinary tract infection (UTI) and who were prescribed parenteral empirical antibiotic therapy by the attending physician were included. Bacteria were identified and antibiotic susceptibility was determined by standard microbiological methods. Adherence to the guidelines was defined as prescribing the empiric antibiotic concordant with the national guidelines on the empirical use of antibiotics.
A total of 160 bacterial isolates were obtained from 158 patients with positive cultures, the majority were from UTIs (n = 56). The selection of empirical antibiotics was concordant with the national guidelines in 92.4% of patients and 29.5% of the bacterial isolates obtained from these patients were resistant to the prescribed empiric antibiotic. Only 47.5% (76/160) of the bacterial isolates were sensitive to the empiric antibiotic and therefore can be considered an appropriate antibiotic prescription.
Empirical antibiotic guidelines should be updated based on the latest surveillance data and information on prevailing bacterial spectra. Antibiotic prescribing patterns and guideline concordance should be periodically evaluated to ensure whether antimicrobial stewardship programs are moving in the right direction.
摘要：
背景：已经制定了经验性抗生素选择指南，以改善患者预后并减少不必要的抗生素使用。我们评估了在三级护理中心针对三种选定感染选择肠胃外经验性抗生素的国家指南的遵守程度。
方法：在斯里兰卡一家三级保健医院的内科和外科病房进行了一项前瞻性横断面研究。下呼吸道感染（LRTI）培养阳性的成年患者，皮肤和软组织感染（SSTI），包括或尿路感染（UTI）以及由主治医师开处方的肠胃外经验性抗生素治疗的患者。通过标准微生物学方法鉴定细菌并确定抗生素敏感性。遵守指南的定义是处方经验性抗生素与经验性使用抗生素的国家指南一致。
结果：从158例培养阳性的患者中共获得160株细菌，大多数来自UTI（n=56）。在92.4％的患者中，经验性抗生素的选择符合国家指南，从这些患者中获得的29.5％的细菌分离株对规定的经验性抗生素具有抗性。只有47.5％（76/160）的细菌分离株对经验性抗生素敏感，因此可以认为是合适的抗生素处方。
结论：经验性抗生素指南应根据最新的监测数据和流行细菌谱信息进行更新。应定期评估抗生素处方模式和指南一致性，以确保抗菌药物管理计划是否朝着正确的方向发展。
方法：在斯里兰卡一家三级保健医院的内科和外科病房进行了一项前瞻性横断面研究。下呼吸道感染（LRTI）培养阳性的成年患者，皮肤和软组织感染（SSTI），包括或尿路感染（UTI）以及由主治医师开处方的肠胃外经验性抗生素治疗的患者。通过标准微生物学方法鉴定细菌并确定抗生素敏感性。遵守指南的定义是处方经验性抗生素与经验性使用抗生素的国家指南一致。
结果：从158例培养阳性的患者中共获得160株细菌，大多数来自UTI（n=56）。在92.4％的患者中，经验性抗生素的选择符合国家指南，从这些患者中获得的29.5％的细菌分离株对规定的经验性抗生素具有抗性。只有47.5％（76/160）的细菌分离株对经验性抗生素敏感，因此可以认为是合适的抗生素处方。
结论：经验性抗生素指南应根据最新的监测数据和流行细菌谱信息进行更新。应定期评估抗生素处方模式和指南一致性，以确保抗菌药物管理计划是否朝着正确的方向发展。
