Antibiotic prescribing in medical intensive care units – a comparison between two private sector hospitals in Central India

The objectives of the present study were to provide a snapshot analysis of antibiotic appropriateness in two hospitals in Southern Italy in three specific areas, surgical, medical and intensive care, and to evaluate the risk factors associated with inappropriateness in antimicrobial prescriptions. We conducted a multicentre observational study in two hospitals in the Campania region. We collected data of all patients admitted on the day of evaluation to antibiotic therapy or prophylaxis through a case report form. The primary outcome was to assess the inappropriateness of antibiotic prescribing, related to the spectrum, dose, route of administration and duration of treatment—in particular, to assess whether there was a difference in the adequacy of the prescriptive practice in the medical, surgical and intensive sectors. Prescriptive inappropriateness was more frequently observed in surgical units (79.8% of the 104 antimicrobial prescriptions) than in medical units (53.8% of the 65 prescriptions, p = 0.0003) or in intensive care units (64.1% of the 39 prescriptions, p = 0.052). The reasons for the inappropriate antimicrobial prescriptions were similar in the three areas evaluated: antimicrobial unnecessary and antimicrobial not recommended were the most frequent reasons for inappropriateness. Not participating in an antimicrobial stewardship program (ASP) was identified as a factor associated with inappropriate antimicrobial prescriptions in medical and surgical units, but not in Intensive Care Units (ICUs). ASPs may enhance the appropriateness of antimicrobial prescriptions especially in medical and surgical units. In ICUs, specific programs able to limit empirical therapies and encourage the collection of microbiological samples may be useful to set up targeted therapies and to design antimicrobial protocols.

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An evaluation of antibiotic prescribing patterns in adult intensive care units in a private hospital in KwaZulu-Natal

Southern African Journal of Infectious Diseases ◽

10.1080/23120053.2015.1103956 ◽

2015 ◽

Vol 30 (1) ◽

pp. 17-22 ◽

Cited By ~ 1

Author(s):

Dipika Chunnilall ◽

Abdool Peer ◽

Indirani Naidoo ◽

Sabiha Essack

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Private Hospital ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Kwazulu Natal

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Antibiotic Prescribing among Pediatric Inpatients with Potential Infections in Two Private Sector Hospitals in Central India

PLoS ONE ◽

10.1371/journal.pone.0142317 ◽

2015 ◽

Vol 10 (11) ◽

pp. e0142317 ◽

Cited By ~ 15

Author(s):

Megha Sharma ◽

Anna Damlin ◽

Ashish Pathak ◽

Cecilia Stålsby Lundborg

Keyword(s):

Private Sector ◽

Central India ◽

Antibiotic Prescribing

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A pilot survey of the current scope of the practice of South African physiotherapists in the intensive care units

South African Journal of Physiotherapy ◽

10.4102/sajp.v61i1.167 ◽

2005 ◽

Vol 61 (1) ◽

Cited By ~ 1

Author(s):

H. Van Aswegen ◽

J. Patterson

Keyword(s):

Intensive Care ◽

Private Sector ◽

South African ◽

Intensive Care Units ◽

The South ◽

Pilot Survey ◽

Private Practitioners ◽

European Survey ◽

The Government

Objective: A pilot study was conducted to determine the currentscope of practice of South African physiotherapists working in intensive care units in the government and the private sectors. These findings were compared to the findings from a European survey with regard to the role of the physiotherapist in European intensive care units.Methodology: Ninety questionnaires were distributed nationwide to secondary and tertiary government hospitals as well as to private practitioners involved in cardiopulmonary physiotherapy. The private practitioners included in this survey were listed in the Private Practitioners Association Official Members Directory. Junior and senior physiotherapists working in the intensive care units of their respective hospitals participated in completing the questionnaire. Comparisons between government and private sector data and between the South African survey and the European survey were carried out using the 2test for non-parametric data. A p-value of less than 0.05 was considered to be statistically significant.Results: Fifty-four questionnaires were analyzed and represented 60% of questionnaires sent out. Respondents to the South African survey reported 28% percent of all ICUs had between 9 - 12 beds; 83% physiotherapists indicated the availability of an on-call service during the night and 96% physiotherapists had a weekend physiotherapy service. Ninety-two percent of physiotherapists working in the government sector supervised students compared to 44% of physiotherapists in the private sector. Between 9% and 27% of physiotherapists in government and private hospitalsactively participated in research in ICU. There were no statistically significant differences in the use of respiratory physiotherapy, mobilization and positioning between respondents to the European survey and those of the South African survey respectively.Conclusion: The response rate to this questionnaire was good. It was evident from this pilot survey that the scope of practice of physiotherapy in ICU didn’t differ significantly between the government and private sector in South Africa. The role of the intensive care physiotherapist in South Africa was similar to that of the European physiotherapist working in ICU.

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COMPARISON OF GRAM NEGATIVE ISOLATES AND SUSCEPTIBILITY FROM SURGICAL AND MEDICAL INTENSIVE CARE UNITS

Anesthesiology ◽

10.1097/00000542-200309001-00029 ◽

2003 ◽

Vol 99 (Supplement) ◽

pp. B47

Author(s):

Richard M. Pino ◽

Richard B. Dew ◽

Jane D. Spargo ◽

Mary Jane Ferraro

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Gram Negative ◽

Medical Intensive Care

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Abstract 301: Differential Outcomes for Geriatric Patients in Cardiac Intensive Care Unit Compared to Medical Intensive Care Unit

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.301 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Caroline Ong ◽

Albert Lui ◽

John A Dodson ◽

Jordan B Strom ◽

Carlos Alviar

Keyword(s):

Older Adults ◽

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Units ◽

Medical Center ◽

Older Age ◽

Icu Mortality ◽

Differential Outcomes ◽

Medical Intensive Care ◽

Cardiac Intensive Care

Background: The number of older adults admitted to cardiac intensive care units (CICU) have been increasing over the past decade, but it is not known if outcomes vary between CICU and medical intensive care units (MICU). We aimed to describe survival and length of stay (LOS) in older adults admitted to CICU and MICU. Methods: All patients admitted to the CICU or MICU at Beth Israel Deaconess Medical Center from 2001-2012 were identified from MIMIC-III, a large single-center critical care database containing deidentified clinical data for 38,597 patients. Our primary outcomes were ICU mortality and ICU LOS. Regression analyses were performed adjusting for age, gender, ICU setting and Oxford Acute Severity of Illness Score (OASIS), a severity score developed and validated in critically ill patients for ICU mortality. Results: We included 21,088 MICU patients (48.3% female) and 7,726 CICU patients (42% female). Unadjusted mortality was 13.7% in MICU and 12.5% in CICU (p=0.11). When adjusted for age, gender and OASIS, there was no difference in mortality between MICU and CICU (OR 0.62, 95% CI 0.34-1.13, p=0.15). However, we found a significant interaction between older age and type of ICU with mortality (p=0.03) but not with ICU LOS (p=0.15). In patients >75 years (6,837 in MICU and 3,161 in CICU), each 5-year interval of older age was associated with higher mortality when adjusted for gender and OASIS in the CICU (OR 1.05, 95% CI 1.02-1.08 p=0.002), but not in the MICU (OR 1.01, 95% CI 0.99-1.03, p=0.15, Figure). Conclusion: Older adults admitted to the CICU had higher adjusted mortality by age group after age 75, as opposed to older MICU patients in whom mortality was high but remained unchanged after age 75.

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A multicentered pharmacoepidemiological approach to evaluate clinically significant potential drug–drug interactions in medical intensive care settings in Pakistan

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907918765510 ◽

2018 ◽

Vol 25 (4) ◽

pp. 190-195 ◽

Cited By ~ 1

Author(s):

Faisal Shakeel ◽

Jamshaid Ali Khan ◽

Muhammad Aamir ◽

Syed Muhammad Asim ◽

Irfan Ullah

Keyword(s):

Intensive Care ◽

Drug Interactions ◽

Intensive Care Units ◽

Potential Drug ◽

Significant Potential ◽

Significant Difference ◽

Tertiary Hospitals ◽

Medical Intensive Care ◽

Clinically Significant ◽

Multiple Drugs

Background: Iatrogenic injuries due to drug–drug interactions are particularly significant in critical care units because of the severely compromised state of the patient. The risk further increases with the use of multiple drugs, increasing age, and stay of the patient. Objective: The aim was to assess potential drug–drug interactions, evaluate clinically significant potential drug–drug interactions and their predictors in medical intensive care units of tertiary hospitals in Pakistan. Methods: Analysis of patient data collected from medical intensive care units of tertiary hospitals in Pakistan were carried out using Micromedex DrugReax. Various statistical tools were applied to identify the significance of associated predictors. Results: In a total of 830 patients, prevalence of potential drug–drug interactions was found to be 39%. These attributed to 190 drug combinations, of which 15.4% were clinically significant. A significant association of potential drug–drug interactions was present with number of prescribed drugs, age, and gender. In terms of clinically significant potential drug–drug interactions, the association was significant with increasing age. Moreover, one-way analysis of variance revealed a significant difference in the means of potential drug–drug interactions among the four hospitals. Conclusion: A prevalence of 39% potential drug–drug interactions was observed in patients of medical intensive care unit, with 22.8% being clinically significant. These attributed to nine drug pairs and could easily be avoided to reduce the risk of adverse effects from potential drug–drug interactions.

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