Retrospective Evaluation of Piperacillin-Tazobactam, Imipenem and Meropenem Used in Surgical Ward at HPSF

Background This research is to retrospectively evaluate the usage of broad-spectrum antibiotics specifically piperacillin/tazobactam, meropenem and imipenem at the surgical wards in Hospital Pakar Sultanah Fatimah (HPSF). The appropriateness will be evaluated based on the prescription of antibiotic with or without culture and sensitivity test request, discontinuation of antibiotic with negative culture test, and proper de-escalation based on culture and sensitivity test.

Methodology The study involved all 81 adult patients age 12 and above who were admitted to Ward 4, Ward 5 (both are surgical wards) and Intensive Care Unit under Surgical Review. These patients were treated by each one of these three broad-spectrum antibiotics namely Imipenem, Meropenem, and PiperacillinTazobactam during a period of one year from 1st January 2018 to 31st December 2018. Data were analyzed by using Microsoft Excel 2016 and SPSS 22.

Result There were 68 patients who were prescribed with antibiotic and had culture and sensitivity test request and result. Meanwhile the other 13 patients were started on the broad-spectrum antibiotics (p=0.188). 49 patients who were continued on receiving broadspectrum antibiotics despite having negative test result (p= 0.243). 65 patients did not have de-escalation and remaining 16 patients were de-escalated to either cefuroxime, amoxicillinclavulanate, ampicillinsulbactam, ceftriaxone or ciprofloxacin. (p=1.51).

Conclusion A study in surgical ward has been done in order to identify the usage of 3 types of antibiotics which is PiperacillinTazobactam, Meropenem and imipenem. From this study, a total 81 patients who receive at least one antibiotic, 84% of it has conduct culture and sensitivity test and the rest is not. Then, 60% of continuation of antibiotics has been done despite negative growth of microorganism. This is largely due to the clinical practice by specialist. Lastly, only 13% were de-escalated to narrow spectrum of antibiotics after culture sensitivity result come out