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Published on: August 30, 2018
Knowledge, Perception, and Antibiotic Prescribing Practice in the Intensive Care Unit: Findings from the Malaysian
Muhammad Azrai Rozali1,2, Norny Syafinaz Abd Rahman1, Helmi Sulaiman3
1Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia.
Introduction:
Approach to managing infection in the intensive care unit (ICU) often varies between institutions and not many readily adapt to available local guidelines despite it was constructed to suite local clinical scenario. Malaysia already has two published guidelines on managing infection in the ICU but data on its compliance are largely unknown.
Objectives:
A cross-sectional survey was carried out and sent to a total of 868 specialists working primarily in the ICU. The aim of this study was to explore knowledge, perception, and the antibiotic prescribing practice among specialists and advanced trainees in Malaysian ICU.
Materials And Methods:
A cross-sectional survey was used, consisted of three sections: knowledge, perception, and antibiotic prescribing practice in ICU. Three case vignettes on hospital-acquired pneumonia (HAP), infected necrotizing pancreatitis (INP), and catheter-related bloodstream infection (CRBSI) were used to explore antibiotic prescribing practice.
Results:
A total of 868 eligible subjects were approached with 104 responded to the survey. Three hundred eighty-nine antibiotics were chosen from seven different classes in the case vignettes. All respondents acknowledged the importance of pharmacokinetic/pharmacodynamic (PK/PD) in antibiotic optimization and majority (97.2%) perceived that current dosing is inadequate to achieve optimal PK/PD target in ICU patients. Majority (85.6%) believed that antibiotic dose should be streamlined to the organisms' minimum inhibitory concentration (MIC). In terms of knowledge, only 64.4% provided the correct correlations between antibiotics and their respective PK/PD targets. Compliance rates in terms of antibiotic choices were at 79.8%, 77.8%, and 27.9% for HAI, INP, and CRBSI, respectively.
Conclusion:
Malaysian physicians are receptive to use PK/PD approach to optimize antibiotic dosing in ICU patients. Nonetheless, there are still gaps in the knowledge of antibiotic PK/PD as well as its application in the critically ill, especially for β-lactams.
Insights
Malaysian ICU specialists understand the importance of pharmacokinetic/pharmacodynamic (PK/PD) principles for antibiotic optimization. However, knowledge gaps persist, particularly regarding PK/PD targets and application in critically ill patients.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Clinical Pharmacy
Background:
- Management of intensive care unit (ICU) infections often lacks standardization, with limited adherence to local guidelines.
- Malaysia has existing ICU infection management guidelines, but compliance data is scarce.
Purpose of the Study:
- To assess knowledge, perception, and antibiotic prescribing practices among Malaysian ICU specialists and trainees.
- To explore the adoption of pharmacokinetic/pharmacodynamic (PK/PD) principles in antibiotic therapy within Malaysian ICUs.
Main Methods:
- A cross-sectional survey was administered to 868 ICU specialists and advanced trainees.
- The survey included sections on knowledge, perception, and antibiotic prescribing practices, utilizing case vignettes for hospital-acquired pneumonia (HAP), infected necrotizing pancreatitis (INP), and catheter-related bloodstream infection (CRBSI).
Main Results:
- 104 specialists responded, with all recognizing the importance of PK/PD for antibiotic optimization.
- A majority perceived current dosing as inadequate for optimal PK/PD targets (97.2%) and supported streamlining doses to minimum inhibitory concentration (MIC) (85.6%).
- Knowledge gaps were identified, with only 64.4% correctly correlating antibiotics with PK/PD targets. Compliance rates varied significantly by infection type: HAP (79.8%), INP (77.8%), and CRBSI (27.9%).
Conclusions:
- Malaysian physicians demonstrate receptiveness to utilizing PK/PD approaches for optimizing antibiotic dosing in ICU patients.
- Significant gaps in knowledge and application of antibiotic PK/PD principles, especially for beta-lactams, remain among critically ill patients.
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