Antibiotic Administration in the Intensive Care Units (ICUs) of a Tertiary Care Hospital of Tirana, Albania

In intensive care units (ICUs) patient conditions, signs of infection and inflammation are similar, making the diagnosis of bacterial infections difficult. As a general rule to prevent or cure the disease caused by an unknown agent, antibiotics may therefore be overused, contributing to the development of antibiotic-resistant bacteria. The aim of this study was to determine the pattern of antibiotics administered in the ICUs and to compare these practices with international standards to identify possible improvement. The study was conducted in October 2015 at four ICUs at the University Hospital Centre Mother Teresa in Tirana, Albania with an overall capacity of 50 beds. Data were collected using a ward form and a patient form referring to the Global Point Prevalence Survey (Global PPS) methodology. The patients form was fulfilled for all inpatients under antibiotic treatment at 8 a. m on the day of the survey. A total of 17 types of antibiotics were used, which an average of 1.4 antibiotics per patient. In our study, 8 patients (16.3 %) out of 49 patients did not receive any antibiotic, whereas the remaining 41 (83.7 %) patients received one or more antibiotic. The reason to prescribe the antibiotic therapy was determined in 46 out of 49 cases (94 %) and most frequently empiric antibiotics were chosen to ensure coverage against the most-likely microorganism only on the base of the presumed source of infection. The most commonly prescribed antibiotic was ceftriaxone (10.2 %) followed by ciprofloxacin (8.2 %), and meropenem (4.1 %). Due to the large number of healthcare workers and the possible transmission of pathogenic bacteria from patient to patient, ICUs are high-risk wards with for the spread of antibiotic-resistance bacteria. Prompt collection of culture reports and early set-up of a culture directed antibiotic regime, including a possible de-escalation when possible is imperative. This will require early and regular consultation with the Microbiology Department to identify common isolates, their antibiotic sensitivity by antibiograms and the appropriate treatment protocol. These data suggest that an Antibiotic Control Policy needs to be established in the ICUs and a multidisciplinary approach should be developed for a correct and specific antibiotic administration.