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Abstract：
Background: There are concerns with inappropriate prescribing of antibiotics in hospitals especially broad spectrum in Pakistan and the subsequent impact on antimicrobial resistance rates. One recognized way to reduce inappropriate prescribing is for empiric therapy to be adjusted according to the result of culture sensitivity reports. Objective: Using culture sensitivity reports to optimize antibiotic prescribing in a teaching hospital in Pakistan. Methods: A retrospective observational study was undertaken in Ghurki Trust Teaching Hospital. A total of 465 positive cultures were taken from patients during the study period (May 2018 and December 2018). The results of pathogen identification and susceptibility testing from patient-infected sites were assessed. Additional data was collected from the patient\'s medical file. This included demographic data, sample type, causative microbe, antimicrobial treatment, and whether empiric or definitive treatment as well as medicine costs. Antimicrobial data was assessed using World Health Organization\'s Defined Daily Dose methodology. Results: A total of 497 isolates were detected from the 465 patient samples as 32 patients had polymicrobes, which included 309 g-negative rods and 188 g-positive cocci. Out of 497 isolates, the most common Gram-positive pathogen isolated was Staphylococcus aureus (Methicillin-sensitive Staphylococcus aureus) (125) (25.1%) and the most common Gram-negative pathogen was Escherichia coli (140) (28.1%). Most of the gram-negative isolates were found to be resistant to ampicillin and co-amoxiclav. Most of the Acinetobacter baumannii isolates were resistant to carbapenems. Gram-positive bacteria showed the maximum sensitivity to linezolid and vancomycin. The most widely used antibiotics for empiric therapy were cefoperazone plus sulbactam, ceftriaxone, amikacin, vancomycin, and metronidazole whereas high use of linezolid, clindamycin, meropenem, and piperacillin + tazobactam was seen in definitive treatment. Empiric therapy was adjusted in 220 (71.1%) cases of Gram-negative infections and 134 (71.2%) cases of Gram-positive infections. Compared with empiric therapy, there was a 13.8% reduction in the number of antibiotics in definitive treatment. The average cost of antibiotics in definitive treatment was less than seen with empiric treatment (8.2%) and the length of hospitalization also decreased. Conclusions: Culture sensitivity reports helped reduced antibiotic utilization and costs as well as helped select the most appropriate treatment. We also found an urgent need for implementing antimicrobial stewardship programs in hospitals and the development of hospital antibiotic guidelines to reduce unnecessary prescribing of broad-spectrum antibiotics.
摘要：
背景：在巴基斯坦，医院特别是广谱的抗生素处方不当以及随后对抗生素耐药率的影响令人担忧。减少不适当处方的一种公认方法是根据培养敏感性报告的结果调整经验性治疗。目的：使用文化敏感性报告优化巴基斯坦一家教学医院的抗生素处方。方法：在GhurkiTrust教学医院进行回顾性观察性研究。在研究期间（2018年5月和2018年12月），总共从患者中采集了465个阳性培养物。评估了患者感染部位的病原体鉴定和敏感性测试的结果。从患者的医疗档案中收集其他数据。这包括人口统计数据，样品类型,致病微生物，抗菌治疗，以及经验性或确定性治疗以及药物成本。抗菌数据使用世界卫生组织定义的每日剂量方法进行评估。结果：从465个患者样本中检测到497个分离株，因为32个患者存在微生物，其中包括309克阴性杆菌和188克阳性球菌。在497个分离株中，最常见的革兰氏阳性病原菌是金黄色葡萄球菌(甲氧西林敏感金黄色葡萄球菌)(125)(25.1%),最常见的革兰氏阴性病原菌是大肠杆菌(140)(28.1%).发现大多数革兰氏阴性分离株对氨苄青霉素和co-amoxiclav具有抗性。大多数鲍曼不动杆菌对碳青霉烯类抗生素耐药。革兰阳性菌对利奈唑胺和万古霉素的敏感性最高。经验性治疗最广泛使用的抗生素是头孢哌酮加舒巴坦，头孢曲松,阿米卡星，万古霉素,和甲硝唑，而利奈唑胺的使用率高，克林霉素,美罗培南,哌拉西林+他唑巴坦在确定性治疗中可见。在220例（71.1％）革兰氏阴性感染和134例（71.2％）革兰氏阳性感染中调整了经验性治疗。与经验性治疗相比，在确定性治疗中,抗生素的使用数量减少了13.8%.确定性治疗中抗生素的平均费用低于经验性治疗（8.2％），住院时间也减少了。结论：培养敏感性报告有助于降低抗生素利用率和成本，并有助于选择最合适的治疗方法。我们还发现迫切需要在医院实施抗菌药物管理计划，并制定医院抗生素指南，以减少不必要的广谱抗生素处方。
