Associated Factors and Impacts of Inappropriate Use of Antibiotics after Documented Gram-Negative Bacteremia at the Medical Wards of Lampang Hospital

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Pornkamol Boripatkosol


Background: Antimicrobial resistance due to inappropriate use of antibiotics in gram-negative bacteremia is recognized as a growing and significant healthcare problem.

Objective: To determine the prevalence, associated factors and treatment outcomes of the inappropriate use of antibiotics after documented gramnegative bacteremia.

Material and method: A retrospective cohort study was conducted among patients over 18 years of age who received antibiotic medication for gram-negative bacteremia at Lampang Hospital between 1 January and 30 April 2020. Appropriateness of antibiotic usage was assessed after bacterial identification and drug susceptibility had been documented. Data was statistically compared between the appropriate-usage group and the inappropriate-usage group. Factors associated with inappropriate prescriptions were analyzed.

Results: Among 117 patients enrolled the study, 82 cases were male (70.9%) and the mean age was 65 ± 16.6 years (range, 23-92). The most common pathogens were Escherichia coli 33 cases (28.2%), ESBL producing Escherichia coli 22 cases (18.8%) and Klebsiella pneumoniae 14 cases (12.0%). Inappropriate
prescriptions were found in 68 cases (58.1%). The most common causes were too broad spectrum 34 cases (50%), failure of switching to oral antibiotics 16 cases (23.5%), and ineffective against isolated pathogens 13 cases (19.1%). Factors associated with inappropriate prescriptions were cardiovascular disease (OR 4.6, 95%CI 1.00-20.40, p=0.042) and history of antibiotic utilization 7-days prior to admission (OR 5.9, 95%CI 1.21-29.14, p=0.030). Drug-resistant pathogens were more frequently developed in the inappropriate-usage group than the appropriate-usage group (82.5% vs 7.5%, p<0.001), as well as the
readmission rate (p=0.035).

Conclusions: The prevalence of inappropriate use of antibiotics for treating documented gram-negative bacteremia was as high as 58% of cases, leading to higher incidences of drug-resistant pathogens and readmission rates. Cardiovascular disease and history of antibiotic utilization 7-days prior to admission were significant associated factors.





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Boripatkosol, P. (2021). Associated Factors and Impacts of Inappropriate Use of Antibiotics after Documented Gram-Negative Bacteremia at the Medical Wards of Lampang Hospital. Lampang Medical Journal, 41(2), 84–95. Retrieved from
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