Antibiotic Prescribing Practices in a Tertiary Care Teaching Hospital: A Retrospective Cross-Sectional Analysis

Background Antibiotics are among the most frequently prescribed medications in hospitals, yet a significant portion of their use is inappropriate, contributing to the growing global threat of antimicrobial resistance (AMR). In Pakistan, AMR has reached alarming levels with the rise of multi- and extensively drug-resistant bacteria. This study evaluates antibiotic prescribing practices and the use of culture sensitivity (CS) testing to assess the appropriateness of antibiotic therapy. Methods This cross-sectional retrospective study was conducted in a 500-bed tertiary care teaching hospital in Islamabad, Pakistan, analyzing inpatient records from 2020 to 2022. From over 5000 patient files, 1012 met the inclusion criteria and were reviewed. The study assessed the rationality of antibiotic prescriptions based on the evidence of infection (EoI), clinical parameters, and the presence or absence of CS testing. Statistical analyses, including Chi-square tests, logistic regression, and Cox proportional hazards regression, were applied to determine the association between antibiotic use and patient outcomes. Results Among the 1,012 patients analyzed, 91.8% (n = 929) received one or more antibiotics. However, 30% (n = 274) of these prescriptions were issued without any documented EoI. Only 17.5% of patients underwent CS testing. Patients exposed to five or more antibiotics had a 2.5-fold increased risk of ICU mortality (HR = 2.50, p < 0.001). A positive correlation (r = 0.42, p < 0.001) was found between the number of antibiotics prescribed and the length of hospitalization. Conclusion The findings of this study reveal a high rate of inappropriate antibiotics prescribed without EoI and CS testing. The results emphasize the urgent need for comprehensive Antibiotic Stewardship Programs (ASPs) in hospital settings, particularly focusing on mandatory CS testing protocols. By reducing irrational antibiotic use, these initiatives can significantly mitigate the rise of AMR globally, especially in resource-limited settings. Implementing ASPs not only optimizes antibiotic use but also aligns with the WHO recommendations, demonstrating the effectiveness of multifaceted interventions in minimizing resistance and improving patient outcomes.