Antimicrobial treatment for inpatient bacterial bloodstream infection in Hong Kong (2012-2021)

Abstract

<p>Introduction: <br></p><p>Bloodstream infection (BSI) is one of the leading causes of morbidity and mortality worldwide. Understanding prescribing patterns of antimicrobials for treating BSIs is imperative to improve clinical practices and particularly antibiotic stewardship programmes. <br></p><p>Aims: <br></p><p>To characterize antimicrobial prescriptions of inpatients with bacterial BSIs in relation to characteristics of patients in Hong Kong in 2012-2021. Methods. Individual electronic medical records for patients admitted into Hong Kong public hospitals from January 1, 2012 to December 31, 2021 provided by the Hospital Authority (HA) were utilized to identify BSI patients and events and to characterize related antibiotic prescribing patterns using information on patient demographics, antimicrobial prescriptions, microbiological testing result and antibiogram from antibiotic susceptibility test, etc. <br></p><p>Results: <br></p><p>A total of 116,504 patients with BSI leading to 144,934 BSI events were identified over the study period, with 92.8% and 89.4% of the defined BSI events recorded of empirical and definitive antimicrobial treatment, respectively. Among empirical treated BSI events, 96.5% were prescribed with intravenous agents and amoxicillin/clavulanic acid, piperacillin/tazobactam and meropenem were mostly frequently used. There were 58,337 (43.4%) BSI events receiving monotherapy as empirical treatment. The median duration of definitive treatment was 7 (IQR, 4-13) days, with penicillins/β-lactamase inhibitors being most commonly used for BSIs with Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Citrobacter species. Antipseudomonal penicillins/β-lactamase inhibitors and carbapenems were also prescribed frequently for treating BSIs with various causative pathogens. <br></p><p>Discussion:<br></p><p>The intensive use of broad-spectrum antibiotics in BSI inpatients warrants further investigations about the antimicrobial resistance profile of causative bacteria and the clinical impact of a plenty of antibiotic exposure on BSI patients. Appropriate recommendations could be provided after understanding antibiotic prescribing patterns to improve clinical practice guidelines for BSI treatment<br></p>