Résumé
Background: Children are more prone to suffer from recurrent infections of respiratory tract due to their immature developed airway, lungs, and immunity, which makes lower respiratory tract infections as one of the most commonly encountered diseases in PICU and one of the leading causes of death among children below 5 years of age. Antimicrobials are one of the commonly prescribed drugs for respiratory tract infections which act as double edged sword as it has saved many lives from dreadful infections and also its injudicious use can give rise to antimicrobial resistance that can endanger many patients’ lives. Aim and Objectives: The aim of the study was to analyze the pattern of antimicrobial drugs used in in-patients admitted to pediatric intensive care unit with respiratory tract infections and to identify the factors to decide the selection of antibiotics. Materials and Methods: The present study was conducted in Pediatrics along with Pharmacology Department of VIMS, Bellary. After obtaining approval from the institutional ethics committee, the study was conducted. Patients were enrolled in the study after obtaining written informed consent from the patient’s informants. Children of age group 1?12 years, suffering from infections of respiratory tract admitted in PICU who were treated with antibiotics were analyzed in our study. Based on the clinical presentation, the diagnosis of RTI was done by treating pediatrician. Results: In our institute, children of under 5 age group, that is, 2?5 years, about 40% of patients were hospitalized in PICU. Male patient’s preponderance was present about 57.5%. Common most respiratory infection seen was bronchopneumonia (46.5%), followed by lower respiratory tract infection (20.5%) and lobar pneumonia (14.5%). All of these patients were involved with other associated conditions, namely, febrile convulsions, severe anemia, and respiratory distress. Conclusion: Prescribing pattern in pediatric intensive care unit showed the preference of using two antibiotics to treat respiratory tract infections. Ceftriaxone and combination of amoxicillin + clavulanic acid were preferred as first-line antibiotics. Amikacin and vancomycin were used as secondline drugs. Piperacillin, tazobactam, and vancomycin were the next line antimicrobial agents. These drugs were given to patients by parenteral routes such as IV and IM.
Résumé
Background: Infectious diseases are more frequent and serious in patients with diabetes mellitus and contribute potentially to increased morbidity and mortality. Multidrug-resistant organisms (MDROs) are bacteria resistant to current antibiotic therapy and difficult to treat. Healthy people are at low risk for developing MDRO infections. Wound infection by MDRO in diabetic patients makes them recalcitrant to healing. Aims and Objectives: This study aims to compare the proportion of resistance to multiple antibiotics in infected wounds of diabetic versus non-diabetic patients. Materials and Methods: A total of 200 diabetic and non-diabetic patients with infected wounds aged between 18 and 89 years, attending the surgical outpatient department or admitted to surgical wards, having positive wound cultures were enrolled in the study after obtaining consent. Other laboratory reports such as hemoglobin percentage, random blood sugar (RBS), and total leukocyte count were noted. Data obtained were analyzed using SPSS.v.20. Results: The diabetics (n = 100) had significantly higher RBS levels [186.86 (±75.37) mg/dl] compared to non-diabetics (n = 100) [93.87 (±41.59) mg/dl] (P < 0.0001). The diabetics had significant history of previous antibiotic usage in the past (72%), compared to non-diabetics (58%) (P = 0.003). Gram-negative bacilli most commonly infected diabetics compared to Gram-positive cocci in non-diabetics. Staphylococcus aureus (67%) was the most commonly isolated organism among both diabetics (24%) and non-diabetics (43%). Pseudomonal infections were higher in diabetics (22%) compared to nondiabetics (10%). Diabetics (87%) showed significantly higher prevalence of resistance to multiple antibiotics compared to non-diabetics (69%) (P = 0.002). Antimicrobial agent most frequently reported sensitive, and resistant to most infection causing organisms was amikacin (75%) and ampicillin (93%), respectively, in both groups. Conclusion: S. aureus is the most commonly isolated organism among both groups. Resistance to multiple antibiotics is higher in diabetics. Infection causing organisms is frequently sensitive to amikacin in both groups; however, its use needs care due to increased chance of nephrotoxicity in diabetics.