{
  "abstract": "Background and Importance Empiric antibiotic therapy is essential in the treatment of pneumonia and sepsis requiring respiratory support. However, the antibiotic selection remains a challenge for prescribers.Aim and Objectives This retrospective observational study aimed to evaluate the empiric antibiotic prescription pattern and clinical outcomes in patients with pneumonia and sepsis with different respiratory support.Material and Methods The study was conducted between June 2018 and February 2024 at the Intensive Care Unit (ICU) of a Pulmonology Department of a tertiary care medical centre in Hungary. During the intensive care therapy were used different types of respiratory support. In the group I of patients was used high flow nasal oxygen (HFNO), or low flow nasal oxygen (LFNO), or non-rebreather mask (NRM) and classic non-invasive ventilation (NIV), while patients in the group II required invasive mechanical ventilation. Guideline-adherence (agent selection, dosage), presence of multidrug-resistant (MDR) pathogens, antibiotic exposure, and clinical outcomes (LOS-length of stay, 30-day mortality) were compared between the two groups of patients. Fisher’s exact test and t-test were applied to compare categorical and continuous variables, respectively. p<0.05 was considered to be significant.Results Comparing the two groups we have not found significant differences in empiric guideline-adherent agent selection (51/115, 44.3% and 52/114, 45.6%). However, overall guideline-adherence was significantly higher in case of invasive ventilation (11.1% vs 1.7%, p<0.05). Guideline-adherent agents have not result in significantly better 30-day mortality rate in either of the groups. Group I has shown significantly lower antibiotic exposure and better clinical outcomes than Group II. Significant difference was found between groups (I vs II) in the presence of MDR pathogens (14.3% vs 49.6%, p<0.001), antibiotic exposure (ICU: median 11.5 vs 21 DDD/patient, p<0.001 and total: median 19 vs 27 DDD/patient p<0.05), ICU-LOS (median 5 vs 11 days,%, p<0.001), total LOS (median 11 vs 15 days,%, p<0.001), and 30-day mortality (14.8% vs 68.4%, p<0.001). Moreover, the presence of MDR pathogens significantly increased ICU-LOS, antibiotic exposure, and 30-day mortality rate.Conclusion and Relevance Among invasively ventilated patients MDR pathogens occurred more frequently increasing significantly antibiotic exposure, length of stay, and 30-day mortality rate. However, guideline-adherent antibiotic therapy has not resulted in better clinical outcomes at ICU.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "University of Debrecen, Faculty of Pharmacy Department of Pharmacology, Debrecen, Hungary"
      ],
      "name": "Z Szilágyi"
    },
    {
      "affiliations": [
        "University of Debrecen, Faculty of Pharmacy Department of Pharmacology, Debrecen, Hungary"
      ],
      "name": "A Vaskó"
    },
    {
      "affiliations": [
        "University of Debrecen, Faculty of Pharmacy Department of Pharmacology, Debrecen, Hungary"
      ],
      "name": "Z Beniczky"
    },
    {
      "affiliations": [
        "University of Debrecen, Faculty of Pharmacy Department of Pharmacology, Debrecen, Hungary"
      ],
      "name": "E Varga"
    },
    {
      "affiliations": [
        "University of Debrecen, Faculty of Pharmacy Department of Pharmaceutical Technology, Debrecen, Hungary"
      ],
      "name": "I Bácskay"
    },
    {
      "affiliations": [
        "University of Debrecen, Faculty of Medicine- Department of Emergency Care and Oxyology, Debrecen, Hungary"
      ],
      "name": "S Somodi"
    },
    {
      "affiliations": [
        "University of Debrecen, Faculty of Pharmacy Department of Pharmacology, Debrecen, Hungary"
      ],
      "name": "I Lekli"
    },
    {
      "affiliations": [
        "University of Debrecen, Faculty of Pharmacy Department of Pharmacology, Debrecen, Hungary"
      ],
      "name": "A Fésüs"
    }
  ],
  "title": "4CPS-047 Evaluation of the empiric antibiotic use pattern and outcomes in patients admitted at ICU with pneumonia and sepsis with different respiratory support",
  "uid": "b6a686e7-8629-50d3-8615-b7b2e4fbed06"
}