PHÂN TÍCH TÌNH HÌNH SỬ DỤNG KHÁNG SINH TRONG ĐIỀU TRỊ NHIỄM KHUẨN GRAM ÂM ĐA KHÁNG TẠI BỆNH VIỆN ĐA KHOA ĐỒNG NAI

Abstract

Objectives: The aims of this study were to analyze the antibiotic resistance and the antibiotic used in treatment of multidrug-resistant gram-negative bacteria, to evaluate the appropriateness of antimicrobial therapy according to guidelines; and to identify risk factors contributing to treatment failures. Methods: We conducted a cross-sectional descriptive and retrospectively study. Results of susceptibility testing and medical records of patients with Acinetobacter baumannii or Klebsiella pneumonia or Pseudomonas aeruginosa infections at ICU and respiratory department of Dong Nai hospital from 1^st January, 2018 to 31th December, 2018 were collected. Results: There were 301 patients’ medical records included. 32 drugs in 14 antibiotic groups were selected to treat infection: penicillin 96.6%, carbapenem 58.5% and quinolon 30.9%. Combination of 2 antibiotic was preferred (50.2% and 49.1% before and after antibiogram), in which the combination of quinolone and betalactam 33.2%. The rate of antibiotic which suitable to antibiogram before and after the microbiologic results were 35.8% and 54.3%. The majority of antibiotics used compliance to current guidelines (61.6%).  Factors contributing to treatment failures were using ventilator/ being admitted to ICU. Using ventilation (OR = 5.2; 95% CI: 2.07 ÷ 13.07; P <0.001), being admitted to ICU (OR = 12.8; 95% CI: 4.61 ÷ 35.54; P <0.001). Using sensitive antibiotics for more than 7 days reduces the risk of treatment failure (OR 0.41; 95% CI: 0.19 ÷ 0.89; P = 0.024). Conclusions: The use of antibiotics in treatment of  multi-drug resistant gram-negative bacteria infections was highly adhered to microbiologic result or current guidelines. Using ventilator or being admitted to ICU were the factors associated with patients’ outcomes.