Presentation (CTI)

OBJECTIVES: The current study assesses the adequacy of empirical antibiotic therapy, de-escalation practices being practiced, and the patterns of antimicrobial resistance among hospitalized patients.
METHODS: A prospective observational approach was used, covering adults, children, and ICU patients who were started on empirical antibiotics. Information was gathered on patient characteristics, clinical presentation, the initial antibiotic selected, culture findings, and any changes made to treatment afterward. Appropriateness of both empirical therapy and de-escalation was judged using predefined criteria. Antimicrobial susceptibility patterns were later analyzed with SPSS.
RESULTS: Among the 300 patients enrolled, nearly 90% were children, and around 60% were male. Respiratory infections were the most common (34.7%), followed by urinary (24.3%) and gastrointestinal infections (14.3%). Gram-negative bacteria dominated the isolates (71.8%). Most prescriptions involved a single antibiotic, with ceftriaxone being used most frequently. It was also the drug most often involved in de-escalation, which typically followed clinical improvement or negative culture reports. Empirical therapy met appropriateness criteria in 75.7% of cases, while de-escalation was appropriate in 71%. Overall, about two-thirds of patients received appropriate antibiotic therapy. Clinical cure was observed in 67.3% of patients, and treatment failure was uncommon (2%). Patients who received adequate empirical therapy had noticeably better outcomes. Culture testing made a substantial difference, increasing the likelihood of appropriate therapy from 44.2% to 72.6%. Resistance was highest against ceftriaxone, amoxicillin-clavulanate, and ciprofloxacin. Carbapenems, linezolid, vancomycin, and nitrofurantoin remained largely effective. MDR and XDR rates were 11.3% and 2.8% respectively, with no PDR isolates.
CONCLUSIONS: Early culture testing, appropriate empirical selection, and timely de-escalation were associated with better antibiotic use and clinical outcomes. Continued focus on these practices and regular AMR monitoring remains essential.