Antibiotic prescription in critical care units in Sri Lanka: a prospective multi-centre survey

Introduction: Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed.We conducted a survey of antibiotics prescribed in critical care (CC) units in Sri Lanka to identify areas for improvement.Methods: Data was collected using a questionnaire from selected CC units in six tertiary care hospitals across Sri Lanka over six months. Data was collected on one particular day in every 2nd and 4th week of the month. Data was compiled using a google sheet and it was analyzed using R language.Results: Data from 237 adult patients was analyzed. Antibiotics were commenced according to microbiology advice (39%), local guidelines (14%), culture results (5.9%), a combination of above (27.1%) and in 14%, none of the above. A majority (39%) were prescribed two antimicrobials, whereas 35%, 18% and 5.9% were on one, three and four antibiotics respectively. The most common indication was hospital acquired pneumonia (HAP)(29.1%), followed by community acquired pneumonia (20%). In 25% of patients, no specific indication for antibiotics was noted. Only 47% of patients had all their antibiotics reviewed and updated, whereas antibiotics were not reviewed at all in 43%. The most frequently prescribed antibiotic was meropenem (32.9%) followed by piperacillin-tazobactam (22.3%) and ceftriaxone (20.6%).Conclusion: HAP was the main indication for antibiotics in critical care. Compliance on antibiotic prescription and documentation is inadequate and the extensive use of meropenem remains a cause for concern. Therefore, strict antibiotic stewardship guidelines and regular review of antibiotics are indicated in critical care units.