1. USE OF RESERVE ANTIBIOTICS IN PICU/NICU AT MP SHAH HOSPITAL DESPITE NEGATIVE CULTURES
BY MIRIAM ORANG’
5/10/2017

2. Background
Children admitted to PICU/ NICU are critically ill and they either have an infection when admitted or are at high-risk of acquiring infections because of invasive devices/procedures.
 HAIs have been reported to be in 16–23% of patients admitted in PICUs. Antibiotics are the most commonly used medicines in the Intensive Care Units (ICUs). The use of antibiotics may be helpful in preventing HAIs, but their unnecessary and irrational use has a few serious disadvantages(indian j crit care med 2016)

3. Problem statement
Prolonged and inappropriate use of reserve antibiotics has resulted in emergence of antibiotic resistance which is an important clinical, economic, and public health problem.( WHO 2010)

4. Justification
This kind of surveillance leads to antibiotic stewardship program and proper use. However, availability of such data is limited from most PICU/NICU . The objective of this study is to evaluate the use of reserve antibiotic in relation to diagnosis and culture findings in the PICU/NICU of M P Shah Hospital.

5. Objectives of the study
1)To illustrate the criteria used in prescribing the reserve antibiotics.
2)To state the advantages and disadvantages of use of reserve antibiotics.
3)To illustrate which bacterial organisms that were identified before initiation of reserve antibiotics.

6. Study methodology Study area:MPShah Hospital PICU/NICU
Research design: : Cross-sectional descriptive study done over 5 months. A structured questionnaire is filled for every child who is started on reserve antibiotics.
Study population :Children admitted to PICU/NICU aged from day 1 of life to 16 years.A=20 study participants out of 108.

7. Sampling technique
Convenience sampling was used for this study. This is because few children admitted to PICU/NICU are on reserve antibiotics.
Convenience sampling is non probability sampling where subjects are selected because of their convenient accessibility and proximity to the researcher.

8. Inclusion &Exclusion criteria
Those included in the study were children admitted to PICU/NICU of MP Shah hospital and are on reserve antibiotics aged day 1 of life to 16 years.
Exclusion- Referrals from other hospital already on second line antibiotics.

9. Results
45% of the participants were male compared to females who were 55%.
The highest number of children were premature being 85% of the total number of study participants.
5% of the children had a long stay of more than 1 month in the unit compared to 58% who spent up to 10 days in PICU/NICU.
Most commonly used reserve antibiotics were Meropenem:60% followed by Amikacin:35% and Vancomycin :5%

10. Results CONT.
65% of the study participants were done blood cultures out of which only 10% showed positive bacterial culture.
10% were done tracheal aspirate and 35% were not done any cultures before commencing the reserve antibiotics.
75% of the study participants were done regular follow up on crp,procalcitonin,full haemogram.

11. Conclusion
It is a clear from the study that the right criteria was not followed before prescribing the reserve antibiotics.
Some of the children who were started on reserve antibiotics showed clinical improvement and spent less days in the unit while some took more than 1 month before discharge from the unit

12. Recomendation
There is need for strict criteria which should be followed before prescribing the reserve antibiotics
In PICU/NICU.
There is need for further study to find out how effective the 1st line antibiotic is in comparison with the reserve antibiotics.