The utilization of antibiotics in the management of acute pancreatitis - experience from one transitional country university hospital

Marušić, Srećko and Sičaja, Mario and Kujundžić, Milan and Banić, Marko and Jakšić, Ozren and Vražić, Hrvoje (2008) The utilization of antibiotics in the management of acute pancreatitis - experience from one transitional country university hospital. Collegium Antropologicum, 32 (4). pp. 1189-1194. ISSN 0350-6134

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Abstract

The aim of the study was to analyze the evidence-based use of antibiotic therapy in the treatment of acute pancreatitis and to identify factors influencing the introduction of antibiotic therapy in the setting of transitional country clinical hospital. This retrospective study was conducted at Department of Internal Medicine at University Hospital Dubrava in Zagreb, Croatia. Data were collected from hospital records of patients treated for acute pancreatitis from January 1st, 2005 till December 31st, 2005. Data collected from patients' histories were compared with indications for antibiotic treatment and antibiotics with demonstrated therapeutic efficacy in acute pancreatitis which were obtained from published literature. Logistic regression was used to identify factors with a significant impact on deciding on the introduction of antibiotic therapy, and multivariate analysis was used to identify factors with a significant impact on the cost of treatment. Statistical significance was set at p < 0.05. Antibiotic therapy was used in 67.7% of patients with acute pancreatitis. Combination of amoxicillin plus clavulanic acid was most frequently administered, either as monotherapy or in combination with metronidazole and/or gentamicin (37.3%), followed by cefuroxime (32.8%) and cefoperazone (26.9%). The choice of antibiotic was appropriate in 35.8% of study patients; however in 29.9% of patients who were administered antibiotics had no indication for this therapy; and 46.9% of patients who had indications for receiving antibiotic therapy didn't receive it. In the groups of patients treated with antibiotics, the cost of treatment was significantly higher compared to groups of patients who were not treated with antibiotics (p = 0.0035; p = 0.0026). In addition to antibiotic therapy, the cost of treatment was significantly influenced by the length of hospital stay and treatment at intensive care unit. The use of antibiotics in the setting of transitional country university hospital in patients with acute pancreatitis is not evidence-based. Decision on the introduction of antibiotic therapy is not based on objective parameters of disease severity or evidence of therapeutic efficacy of particular antibiotics. The cost of treatment is significantly increased by the use of antibiotic therapy.

Abstract in Croatian

Ciljevi ove studije uključuju analizu upotrebe antibiotika u liječenju akutnog pankreatitisa u kliničkoj bolnici tranzicijske zemlje, usporedbu s publiciranim smjernicama, uz identifikaciju čimbenika koji utječu na odabir i uvođenje antibiotskog liječenja. Ova retrospektivna studija provedena je na Klinici za internu medicinu Kliničke bolnice »Dubrava«, Zagreb, Hrvatska. Podaci su sakupljeni iz bolničkih arhiva pacijenata koji su liječeni radi akutnog pankreatitisa u razdoblju od 1.1.2005. do 31.12.2005. Tako sakupljeni podaci su uspoređeni sa publiciranim smjernicama za liječenje akutnog pankreatitisa. Logička regresija korištena je sa ciljem identifikacije statistički značajnih čimbenika koji utječu na odluku o uvođenju antibiotske terapije, a multivarijantna analiza je korištena sa ciljem identifikacije čimbenika koji imaju utjecaj na cijenu liječenja. Statistička značajnost zadana je za p<0,05. Antibiotici su korišteni u 67,7% pacijenata koji su liječeni radi akutnog pankreatitisa. Kombinacija amoksicilina i klavulanske kiseline je najčešće propisivani antibiotik, samostalno ili u kombinaciji sa metronidazolom i/ili gentamicinom (37,3%), slijedi cefuroksim (32,8%) i cefoperazon (26,9%). Izbor antibiotika bio je ispravan u 35,8% slučajeva, međutim u 29,9% slučajeva nije bilo indikacije za antibiotskim liječenjem. U skupini pacijenata koji su liječeni antibiotikom, cijena liječenja je bila značajno viša u odnosu na skupinu koja nije bila liječena antibiotikom (p=0,0035; p=0,0026). Cijena liječenja je također bila uvjetovana dužinom intrahospitalnog boravka i liječenjem u jedinici intenzivnog liječenja. Upotreba antibiotika u okružju kliničke bolnice zemlje u tranziciji nije temeljena na dokazima publiciranim u literaturi. Odluka o uvođenju antibiotika nije temeljena na objektivnim parametrima težine bolesti kako ni na terapijskoj učinkovitosti određenog antibiotika. Cijena liječenja značajno je uvjetovana korištenjem antibiotika.

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