Background The correct use of antibiotics in an hospital environment is necessary to ensure the effectiveness of the treatment, the control of resistance and also to avoid the occurrence of adverse reactions.
Purpose Describe the pattern of antimicrobial use in hospitalised adult patients and identify opportunities for improvement.
Material and methods A cross-sectional descriptive study was carried out on 7 March 2017 in adult patients admitted to hospitalised antimicrobial treatment. The following data were collected: sex, age, allergies, service, antimicrobial treatment, type of treatment, culture, antimicrobial coverage by culture and kidney failure. Pharmaceutical interventions performed and opportunities for treatment improvement were assessed after a detailed review of all variables
Results Thirty nine per cent of the 307 patients admitted were treated with an antimicrobial agent, 58 male and 62 female, with a median age of 73.5 years (16–98). The services that more antimicrobial agents were used in were internal medicine (22.5%) and pneumology (20%). 69.2% of antimicrobial treatments were used as monotherapy, 24.2% were used as biterapia and 6.6% three antimicrobials were used together. In 11 of the cases, the treatments were targeted, and 10 prophylactics and most of the treatments were used empirically (99 patients). Of these empirical treatments, 56.7% (57 patients) of the cases did not undergo culture prior to initiation. Of the total number of patients with antimicrobial treatment, 20 patients had renal failure: in 30% (six patients) of these the recommended dosage adjustment was not performed. Eleven patients were found to be allergic to beta-lactam and one of these was prescribed beta-lactam. We found one treatment not indicated for resistance and three cases of non-descalation. In fact, opportunities for improvement have been identified in 70 antimicrobial treatments.
Conclusion The use of antimicrobial treatments in hospitalised patients is quite high, especially in medical services. Most prescribed treatments are empirical and monotherapy. Opportunities for improvement have been identified in 58.3% of patients with antimicrobial therapy. Microbiological culture is necessary for the selection of antimicrobial agents and to optimise the effectiveness of the treatment. Dose adjustment in renal failure and patient allergies may affect patient safety, which justifies the need to implement an electronic prescription integrated with the patient’s medical history.
No conflict of interest
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