Background and importance The global increase in antimicrobial resistance makes it necessary to establish local protocols for the empirical treatment of the different syndromes in hospitals to preserve and optimise the use of antibiotics as much as possible.
Aim and objectives To assess the adequacy of the prescription and the degree of compliance with the ‘protocol of antibiotherapy in intra-abdominal infection (PIAI)’ in a regional hospital.
Material and methods This was a retrospective observational study including patients with abdominal infection treated with antibiotics from May to December 2019. Patients with antibiotic prophylaxis were excluded. In February 2019, the PIAI was approved. The variables included were: age, sex, type of infectious syndrome, prescribed antibiotic, type of therapy (empirical/targeted), need for adjustment to renal function and samples collected for microbiological cultures (MC). Three criteria were established for non-compliance with the protocol: indication, dose and duration. We also recorded: patients with unsuitable prescriptions, reason for non-compliance and pharmaceutical interventions. When the protocol was breached, the pharmacist notified the doctor through an electronic prescription alert system.
Results 65 patients were included (50.8% men) with a median age of 59 years (range 19–95). 38.46% had acute cholecystitis, 16.92% acute diverticulitis, 12.31% acute appendicitis, 4.62% secondary peritonitis, 4.62% surgical wound infection, 3.08% intra-abdominal abscess, 3.08% perianal abscess, 3.08% acute cholangitis, 1.54% acute pancreatitis and 12% other infections.
82 antibiotics were prescribed (amoxicillin/clavulanic 40.2%, piperacillin/tazobactam 26.8%, imipenem/cylastine 9.8%, ertapenem 7.3%, ciprofloxacin+metronidazole 7.3%, and other antibiotics 8.6%). One patient required adjustment to renal function. The average duration of treatment was 7.82 days (SD 4.87). 87.7% of patients received empirical treatment and samples were collected for MC in 17 patients.
The degree of adequacy was 76.3%. 21 cases of inadequacy were identified (long duration=9, incorrect selection=8, incorrect dose=1). 21 pharmaceutical recommendations were recorded. The predominant infectious syndromes in protocol breaches were: 41.2% acute cholecystitis and 29.4% acute diverticulitis. Distribution of unsuitable antibiotics was: piperacillin/tazobactam 41.2%; amoxicillin/clavulanic 23.5%; ciprofloxacin +metronidazole 17.6%; imipenem/cylastine 11.8%; and ertapenem 5.9%.
Conclusion and relevance The adequacy of the prescription to protocol was good. Excessive duration and selection of antibiotics were the main causes of inadequacy. Pharmaceutical validation is essential to promote optimisation and rational use of antibiotics in hospitals. Subsequent and periodic studies are needed to monitor adequacy time.
Conflict of interest No conflict of interest
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