Adherence to International Empiric Antibiotic Treatment Guidelines in a Tertiary Teaching Hospital in Mexico City

Background:

In recent years, the resistance of bacterial organisms to antibiotics is becoming a worldwide problem. This problem has a negative impact in many levels; patients infected with these multiresistant microorganisms, have longer hospitalizations generating a high economic cost. Mortality due to these microorganisms is higher; Moreover, antibiotics used in these cases come through with adverse effects more frequently.

Methods:

A retrospective cohort of patients initiating empiric antibiotic treatment was evaluated (longer than 2 days, excluding surgical prophylaxis) in 2014. It was assessed whether empirical antibiotic therapy adhered to international guidelines; if cultures where performed and obtained from the suspect site of infection; whether antibiotic therapy was adjusted in case of positive cultures and whether the treatment was discontinued once infectious diagnosis was rouled out.

Results:

We evaluated 889 cases in which empirical antibiotic therapy was initiated, with the following findings: Close adherence to empirical antibiotic therapy guidelines was noted in 61.8% of cases. In 40.6% of cases , appropriate samples for culture were obtained from the suspected site of infection. When said cultures were positive for reasonable pathogens, treatment adjustment according to microorganism identification or antibiogram results was noted in 82.7% of cases. In 59% of cases where infection was ruled out, antibiotic therapy was stopped within 5 days.

We compared the cases in which a correct microbiological approach was used vs the ones in which it was not. It was found that the proportion of cases in which an infectious diseases specialist had been consulted within 48 hours was significantly higher in the first group (46.5% vs 1.8%).

Conclusion:

Adherence to international empirical antibiotic therapy guidelines in our hospital approaches 60%; appropriate samples for culture are obtained from suspected sites of infection in a low proportion; in most cases, however, once a presumptive or definitive microbiological diagnosis is performed, therapy adjustment follows. As a conclusion, both the quality of diagnostic work-ups and treatments improve considerably when the infectious diseases department is early and actively involved, thus raising appropriate culture-obtaining and correct therapy rates.