Inadequate Empirical Antibiotic Therapy in Hospital Acquired Pneumonia
Introduction: Inadequate empirical antibiotic therapy for HAP is a common phenomena and one of the indicators of the poor stewardship. This study intended to analyze the efficacy of empirical antibiotics in the light of microbiological data in HAP cases. Methods: Suspected cases of HAP we...
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doaj-9abed94ee1ea4318ad688f6690b9717d2020-11-24T22:51:20ZengNepal Medical AssociationJournal of Nepal Medical Association0028-27151815-672X2015-12-01532002402432738Inadequate Empirical Antibiotic Therapy in Hospital Acquired PneumoniaSantosh Dahal0Basista Prasad Rijal1Karbir Nath Yogi2Jeevan Bahadur Sherchand3Keshab Parajuli4Narayan Parajuli5Bharat Mani Pokhrel6Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.Department of Respiratory Medicine, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.Introduction: Inadequate empirical antibiotic therapy for HAP is a common phenomena and one of the indicators of the poor stewardship. This study intended to analyze the efficacy of empirical antibiotics in the light of microbiological data in HAP cases. Methods: Suspected cases of HAP were followed for clinico-bacterial evidence, antimicrobial resistance and pre and post culture antibiotic use. The study was taken from February,2014 to July, 2014 in department of Microbiology and department of Respiratory medicine prospectively. Data was analyzed by Microsoft Office Excel 2007. Results: Out of 758 cases investigated, 77(10 %) cases were HAP, 65(84%) of them were culture positive and 48(74 %) were late in onset. In early onset cases, isolates were Acinetobacter 10(42%), Escherichia coli 5(21%), S.aureus 4(17%), Klebsiella 1(4%) and Pseudomonas 1(4%). From the late onset cases Acinetobacter 15(28%), Klebsiella 17(32%) and Pseudomonas 13(24%) were isolated. All Acinetobacter, 78% Klebsiella and 36% Pseudomonas isolates were multi drug resistant. Empirical therapies were inadequate in 12(70%) of early onset cases and 44(92%) of late onset type. Cephalosporins were used in 7(41%) of early onset infections but found to be adequate only in 2(12%) cases. Polymyxins were avoided empirically but after cultures were used in 9(19%) cases. Conclusions: Empirical antibiotics were vastly inadequate, more frequently so in late onset infections. Use of cephalosporins empirically in early onset infections and avoiding empirical use of polymyxin antibiotics in late onset infections contributed largely to the findings. Inadequate empirical regimen is a real time feedback for a practitioner to update his knowledge on the local microbiological trends. Keywords: empirical therapy; hospital acquired pneumonia.http://jnma.com.np/jnma/index.php/jnma/article/view/2738 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Santosh Dahal Basista Prasad Rijal Karbir Nath Yogi Jeevan Bahadur Sherchand Keshab Parajuli Narayan Parajuli Bharat Mani Pokhrel |
spellingShingle |
Santosh Dahal Basista Prasad Rijal Karbir Nath Yogi Jeevan Bahadur Sherchand Keshab Parajuli Narayan Parajuli Bharat Mani Pokhrel Inadequate Empirical Antibiotic Therapy in Hospital Acquired Pneumonia Journal of Nepal Medical Association |
author_facet |
Santosh Dahal Basista Prasad Rijal Karbir Nath Yogi Jeevan Bahadur Sherchand Keshab Parajuli Narayan Parajuli Bharat Mani Pokhrel |
author_sort |
Santosh Dahal |
title |
Inadequate Empirical Antibiotic Therapy in Hospital Acquired Pneumonia |
title_short |
Inadequate Empirical Antibiotic Therapy in Hospital Acquired Pneumonia |
title_full |
Inadequate Empirical Antibiotic Therapy in Hospital Acquired Pneumonia |
title_fullStr |
Inadequate Empirical Antibiotic Therapy in Hospital Acquired Pneumonia |
title_full_unstemmed |
Inadequate Empirical Antibiotic Therapy in Hospital Acquired Pneumonia |
title_sort |
inadequate empirical antibiotic therapy in hospital acquired pneumonia |
publisher |
Nepal Medical Association |
series |
Journal of Nepal Medical Association |
issn |
0028-2715 1815-672X |
publishDate |
2015-12-01 |
description |
Introduction: Inadequate empirical antibiotic therapy for HAP is a common phenomena and one of the indicators of the poor stewardship. This study intended to analyze the efficacy of empirical antibiotics in the light of microbiological data in HAP cases.
Methods: Suspected cases of HAP were followed for clinico-bacterial evidence, antimicrobial resistance and pre and post culture antibiotic use. The study was taken from February,2014 to July, 2014 in department of Microbiology and department of Respiratory medicine prospectively. Data was analyzed by Microsoft Office Excel 2007.
Results: Out of 758 cases investigated, 77(10 %) cases were HAP, 65(84%) of them were culture positive and 48(74 %) were late in onset. In early onset cases, isolates were Acinetobacter 10(42%), Escherichia coli 5(21%), S.aureus 4(17%), Klebsiella 1(4%) and Pseudomonas 1(4%). From the late onset cases Acinetobacter 15(28%), Klebsiella 17(32%) and Pseudomonas 13(24%) were isolated. All Acinetobacter, 78% Klebsiella and 36% Pseudomonas isolates were multi drug resistant. Empirical therapies were inadequate in 12(70%) of early onset cases and 44(92%) of late onset type. Cephalosporins were used in 7(41%) of early onset infections but found to be adequate only in 2(12%) cases. Polymyxins were avoided empirically but after cultures were used in 9(19%) cases.
Conclusions: Empirical antibiotics were vastly inadequate, more frequently so in late onset infections. Use of cephalosporins empirically in early onset infections and avoiding empirical use of polymyxin antibiotics in late onset infections contributed largely to the findings. Inadequate empirical regimen is a real time feedback for a practitioner to update his knowledge on the local microbiological trends.
Keywords: empirical therapy; hospital acquired pneumonia. |
url |
http://jnma.com.np/jnma/index.php/jnma/article/view/2738 |
work_keys_str_mv |
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