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Use and misuse of antimicrobial agents in a general hospital in the AIDS era
M Rivero1, B Padilla, J García-Lechuz
1Department of Clinical Microbiology and Infectious Diseases, Hospital General 'Gregorio Marañón', University of Madrid, Madrid, Spain.
Abstract:
A prevalence study was carried out to ascertain the pattern of antimicrobial use, costs and relevance in a general hospital during the AIDS era. All patients receiving antimicrobials were studied. Antimicrobials were divided into antibacterial drugs and others and the costs evaluated in US dollars. Of 1526 patients surveyed, 455 (29.8%) were receiving 664 courses of antimicrobials: 109 (7.2%) as prophylaxis and 346 (22.6%) as treatment. Fifteen percent of courses involved non-antibacterial drugs. In 188 patients (40.9% of those treated) treatment was inadequate, usually because of incorrect drug choice. Daily cost of antimicrobials was $14953. AIDS accounted for 3% of all patients, 9% of those receiving antimicrobials, 19.7% of antimicrobial usage and 9.6% of the antimicrobial expenditure. Misuse occurred in 43% of non-HIV patients and 17% of those with HIV. Thus, despite a disproportionate contribution of patients with AIDS, adequacy of use of antimicrobials was better in this population.
Insights
This study on antimicrobial use in a general hospital found that while patients with Acquired Immunodeficiency Syndrome (AIDS) used more antimicrobials, their treatment was more adequate than non-HIV patients. Antimicrobial misuse was prevalent.
Area of Science:
- Infectious Diseases
- Hospital Pharmacy
- Public Health
Background:
- Antimicrobial use, costs, and relevance were assessed in a general hospital during the Acquired Immunodeficiency Syndrome (AIDS) era.
- Understanding antimicrobial prescribing patterns is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To ascertain the pattern of antimicrobial use, associated costs, and relevance in a general hospital setting.
- To compare antimicrobial use adequacy between patients with and without HIV/AIDS.
Main Methods:
- A prevalence study involving all patients receiving antimicrobials.
- Categorization of antimicrobials into antibacterial drugs and others, with cost evaluation in US dollars.
- Analysis of treatment adequacy based on drug choice and patient population (HIV-positive vs. HIV-negative).
Main Results:
- Out of 1526 patients, 455 (29.8%) received 664 antimicrobial courses; 15% involved non-antibacterial drugs.
- Inadequate treatment occurred in 40.9% of treated patients, primarily due to incorrect drug selection.
- Patients with AIDS accounted for 9% of antimicrobial recipients and 19.7% of usage, but had better treatment adequacy (17% misuse) compared to non-HIV patients (43% misuse).
Conclusions:
- Despite a disproportionate antimicrobial burden, patients with AIDS demonstrated better antimicrobial use adequacy than their non-HIV counterparts.
- Incorrect drug choice was a significant factor in inadequate antimicrobial treatment across the hospital.
- Hospital antimicrobial stewardship programs should address both HIV-positive and HIV-negative patient populations, focusing on appropriate drug selection.