Antibiotic prescribing practices in the presence of extended-spectrum β-lactamase (ESBL) positive organisms in an adult intensive care unit in South Africa – A pilot study

Peer review under responsibility of Alexandria University Faculty of Medicine.

Available online 4 December 2018

Figures & data

Table 1 Baseline demographic and study characteristic information.

Data characteristics	No (%) of Patients (IQR)
Demographic data
Total patients	39 (100%)
Male	29 (72%)
Female	11 (28%)
Age (years), median (IQR)	62.35 (24–92)
LOS in ICU (days)	22.15 (2–63)
Clinical data
Admission diagnosis	n = 39
Intestinal obstruction	5 (13%)
Heart failure	1 (3%)
Malignant neoplasma	2 (5%)
Pulmonary problems	4 (10%)
Respiratory distress	16 (41%)
Sepsis	5 (13%)
Trauma	6 (15%)
UTI	1 (3%)
ICU
MICU	22 (56.4%)
TICU	17 (43.6%)
Charlson score, median (IQR)	5 (3–8)
Community acquired infection (CAI)	3 (7.7%)
Hospital associated infection (HAI)	36 (92.3%)
Origin of the infection
Source of culture	n = 39
Blood	6 (15%)
Lung tissue	1 (3%)
Sputum	22 (56%)
Duodenal swab	1 (3%)
Urine	9 (23%)
Microbiology data	n = 39
Citrobacter koseri	1 (3%)
Escherichia coli	4 (10%)
Enterobacter cloacae	2 (5%)
Enterobacter aerogenes	1 (3%)
Klebsiella pneumoniae	31 (79%)

Table 2 Age adjusted Charlson comorbidity index and clinical outcome (n = 39).

Combined age/co-morbid score	Amount N = 39	Percentage N = 39	Relative risk of death	Clinical outcome percentage (n = 39)
				Survived	Died
0–1	6	15.4%	0–1.45	100	0
2–3	8	20.5%	2.10–3.40	87.5	12.5
4–6	10	25.6%	4.40–9.23	70	30
>6	15	38.5%	9.23–19.37	13.3	86.7

Table 3 Details of the first antimicrobials patients received.

Number of patients (N = 39)	Antimicrobial received and ATC code	Percentage
21	β-lactam (J01C, J01DB to DE)	53.8%
7	Fluoroquinolones (J01MA)	17.9%
3	Carbapenem (J01DH)	7.7%
2	Tetracyclines (tigecycline) J01AA	5.1%
1	Aminoglycosides (J01G)	2.6%
1	Imidazole derivatives (J01XD01) (Metronidazole)	2.6%
1	Other bacterials J01XX (Linezolid)	2.6%
3	Others	5.7%

Table 4 Number of antibiotics patients received before positive ESBL organisms were isolated.

Number of patients (N = 39)	Number of antibiotics prior to ESBL isolate
10	2
8	1
8	3
8	4
3	5
2	0

Table 5 Prescribing practices after positive ESBL producing culture.

Cultures obtained (n = 39)	Sensitivity yes/no/not reported (NR)	Initial Prescribed therapy (frequency) (and ATC code)	TDC (g)	DDD	Appropriate prescribing yes/no/not reported (NR)
Blood (6)
K. pneumoniae (5)	Yes	Doripenem (2) (J01DH04)	3	1.5	Yes
	Yes	Ertapenem (1) (J01DH03)	1	1	Yes
	Yes	Meropenem (1) (J01DH02)	6	3	Yes
	NR	Piperacillin/Tazobactam (1) (J01RA01)	13.5	14	NR
E. cloacae (1)	Yes	Imipenem (1) (J01DH)	4	2	Yes
Sputum (22)
K. pneumoniae (18)	Yes	Cefepime (2) (J01DE01)	4	2	No
	Yes	Ceftriaxone (1) (J01DD04)	2	2	No
	Yes	Ciprofloxacin (1) (J01MA02)	0.8	0.5	No
	Yes	Doripenem (2) (J01DH04)	2.25	1.5	Yes
	Yes	Ertapenem (2) (J01DH03)	2	1	Yes
	Yes	Imipenem (4) (J01DH)	2.5	2	Yes
	Yes	Meropenem (4) (J01DH02)	4.5	3	Yes
	Yes	Moxifloxacin (1) (J01MA14)	0.4	0.4	No
	NR	Tigecycline (1) (J01AA12)	0.2	0.1	NR
No antibiotic received (1)	No
C. Koseri (1)	Yes	Meropenem (1) (J01DH02)	3	3	Yes
E. aerogenes (1)	Yes	Amikacin (1) (J01GB06)	1	1	Yes
E. coli (1)	Yes	Cefepime (1) (J01DE01)	6	2	No
Duodenal swab (1)
K. pneumonia (1)	Yes	Doripenem (1) (J01DH04)	3	1.5	Yes
Lung tissue (1)
K. pneumonia (1)	Yes	Cefepime (1) (J01DE01)	3	2	NR
Urine (9)
Ent. cloacae (1)	Yes	Amoxicillin (1) (J01CA04)	2	1	No
E. coli (3)	Yes	Ciprofloxacin (1) (J01MA02)	0.8	0.5	No
	Yes	Doripenem (1) (J01DH04)	3	1.5	Yes
	Yes	Meropenem (1) (J01DH02)	4	3	Yes
K. pneumonia (5)	Yes	Cefepime (1) (J01DE01)	3	2	No
	Yes	Ertapenem (1) (J01DH03)	2	1	Yes
	Yes	Tigecycline (2) (J01AA12)	0.2	0.1	Yes
	NR	Vancomycin (1) (J01XA01)	2	2	NR

TDC = Total daily consumption; DDD = Defined daily dose; NR = not reported.

Table 6 Clinical outcomes for patients as compared to appropriate vs inappropriate therapy received.

Clinical outcome of patients (N = 39 and % s)	Appropriate therapy received	Inappropriate therapy received	Other		Fischer exact test
			Sensitivity reports not done	Antibiotics not received
Survived (n = 22) – 56.4%	15 (68%)	7 (32%)	–	–	p = 0.209
Deceased (n = 17) – 43.6%	8 (47%)	4 (23%)	4 (24%)	1 (6%)