Economic burden of inappropriate antibiotic use for prophylactic purpose in Shiraz, Iran

Because economic data on the prophylactic usage of antibiotic in Iran are scant, we have conducted a cross-sectional study with provider perspective to measure costs and appropriate use of antibiotics in surgical wards of 6 training hospitals affiliated to Shiraz University of Medical Sciences [SUMS], Iran. Over a six-month period 1,000 consecutive patients undergoing surgical operation were enrolled and information on prophylactic antibiotic administration was collected. The information included basic patient's demographic data, types of surgery, category of antibiotic, dosage, dosage intervals, route of administration, number of doses, initiation times and duration of administration. In order to determine the agreement between prescribed antibiotics and medical indication, the American Society of Health-System Pharmacists [ASHP] guidelines were applied. Nine hundred and ninety three out of 1,000 patients [99.3%] had received at least one antibiotic and 908 patients [91.4%] received antibiotics because of a medical indication. Five out of 913 patients who had indications for antibiotic prophylaxis did not receive any antibiotic. Antibiotics were prescribed for 85 out of 87 [98%] procedures in which an antibiotic was not indicated. The average cost of antibiotic prescription per surgical procedure was 786,936 Iranian Rials [corresponding to 99.60 USD or Eng. pound 82.90]. The most frequent prescribed antibiotic was cefazoline adding 53.3% of the total cost of antibiotics. In total, 36,516,190 Iranian Rials [corresponding to 4,622.95 USD or Eng. pound 3,845.20] were spent for cefazoline alone. The results of this study showed that all surgical patients received at least one antibiotic as prophylaxis for any infection in the surgical site. Our results indicate over- and misuse of antibiotics in Iran leading to a great amount of economic burden, since in 98% of all procedures, antibiotics were used inappropriately

Epidemiology of hospitalized female burns patients in a burn centre in Shiraz

During 2000 to 2001, all 170 female burn patients admitted to the Ghotbeddin burn centre in Shiraz were studied to determine the epidemiological characteristics and outcome of burn for these patients. The overall mortality rate was 64%. The highest frequency of burns [53.5%] occurred among 16-25-year-olds. The commonest cause of burn was flame [98.2%]. The mean [SD] length of hospital stay was 13 [14.3] days. Mean [SD] of total body surface area [TBSA] burned among all patients was 56% [28.5%]; among those who survived it was 29% [13.4%] and among those who died it was 72% [21.7%]. The relation between TBSA and mortality was statistically significant

Vancomycin use in a large teaching hospital in Shiraz, Islamic Republic of Iran, 2003

We investigated adherence to the Hospital Infection Control Practice Advisory Committee [HICPAC] guidelines on vancomycin prescription in a large university-affiliated hospital in Shiraz. From August to December 2003, 200 hospitalized patients received vancomycin. For only 12 [6%] of these patients was vancomycin prescribed appropriately according to HICPAC guidelines. The main reasons why vancomycin use did not comply with HICPAC recommendations were: surgical prophylaxis in patients with negative cultures for resistant Gram-positive organisms, no investigation of vancomycin serum levels in patients receiving > 48 hours of vancomycin, vancomycin serum levels not repeated in patients receiving > 1 week of vancomycin, no appropriate adjustment of dosage with respect to serum levels in patients receiving vancomycin