J. Pharm. Pharmacogn. Res., vol. 14, no. 3, Article ID 2799, May-Jun 2026.
DOI: https://doi.org/10.56499/jppres_14.3.2799Original Article
Appropriateness of antibiotic therapy in sepsis patients in the intensive care unit: A single-center observational study
[Adecuación de la terapia antibiótica en pacientes con sepsis en la unidad de cuidados intensivos: un estudio observacional de un solo centro]
Ha T.T. Dinh1*, Khoi X. Pham1,2, An N. Nguyen1,3
1Faculty of Pharmacy, Lac Hong University, Bien Hoa City, V-81000, Vietnam.
2Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand.
3Department of Pharmacy, Hanoi University of Pharmacy, Hanoi 10000, Vietnam.
*E-mail: thuyha@lhu.edu.vn
Abstract
Context: Sepsis remains a major cause of mortality in intensive care units, and antimicrobial selection is complicated by local resistance patterns.
Aims: To describe antimicrobial use and evaluate the association between guideline adherence and discharge outcomes among adult ICU patients with sepsis or septic shock.
Methods: A retrospective observational cohort study was conducted using 106 medical records from adult patients admitted to the ICU of Dong Nai 2 Hospital between January 2023 and February 2024. Empirical and post-susceptibility antimicrobial regimens were assessed according to the Sanford Guide and VNACCEMT 2020 recommendations.
Results: Respiratory infection was the most frequent source of sepsis. Cultures were performed in 63 patients, and blood cultures were positive in 32. The main pathogens were Klebsiella pneumoniae (38.1%), Acinetobacter baumannii (22.2%), Pseudomonas aeruginosa (14.3%), and methicillin-resistant Staphylococcus aureus (11.1%). Levofloxacin and piperacillin-tazobactam were commonly prescribed empirically, whereas meropenem, linezolid, and colistin were frequently used after susceptibility results. Empirical adherence to Sanford Guide and VNACCEMT recommendations was 32.1% and 56.6%, respectively. Post-susceptibility adherence was 46.4% and 50.0%, respectively. Adherence to the Sanford Guide after susceptibility testing was associated with treatment success at discharge, defined as recovery or improvement (OR 2.301, 95% CI 1.105–4.792; p = 0.026). The in-hospital mortality rate was 41.5%.
Conclusions: Inappropriate empirical antimicrobial therapy was frequent in this high-resistance ICU cohort. Adherence to antimicrobial stewardship recommendations, particularly Sanford Guide-based adjustments after susceptibility results became available, was associated with improved discharge outcomes in the exploratory multivariable analysis. Locally adapted empirical therapy combined with PK/PD-optimized targeted dosing should be evaluated prospectively.
Keywords: antimicrobial stewardship; antimicrobial susceptibility testing; critical care; drug resistance, bacterial; drug resistance, multiple, bacterial; treatment outcome.
Resumen
Contexto: La sepsis sigue siendo una causa importante de mortalidad en las unidades de cuidados intensivos, y la selección de antimicrobianos se ve complicada por los patrones locales de resistencia.
Objetivos: Describir el uso de antimicrobianos y evaluar la asociación entre la adherencia a las guías y los desenlaces al alta en pacientes adultos con sepsis o shock séptico en la UCI.
Métodos: Se llevó a cabo un estudio de cohorte observacional retrospectivo con 106 historias clínicas de pacientes adultos ingresados en la UCI del Hospital Dong Nai 2 entre enero de 2023 y febrero de 2024. Los regímenes antimicrobianos empíricos y posteriores al antibiograma se evaluaron según las recomendaciones de la Sanford Guide y de las guías de la VNACCEMT 2020.
Resultados: La infección respiratoria fue la fuente más frecuente de sepsis. Se realizaron cultivos en 63 pacientes y los hemocultivos resultaron positivos en 32. Los principales patógenos fueron Klebsiella pneumoniae (38,1%), Acinetobacter baumannii (22,2%), Pseudomonas aeruginosa (14,3%) y Staphylococcus aureus resistente a meticilina (11,1%). Levofloxacino y piperacilina-tazobactam se prescribieron con mayor frecuencia como tratamiento empírico, mientras que meropenem, linezolid y colistina se utilizaron con mayor frecuencia tras conocerse los resultados de sensibilidad. La adherencia empírica a las recomendaciones de la Sanford Guide y de VNACCEMT fue del 32,1% y del 56,6%, respectivamente. La adherencia posterior al antibiograma fue del 46,4% y del 50,0%, respectivamente. La adherencia a la Sanford Guide tras las pruebas de sensibilidad se asoció con el éxito terapéutico al alta, definido como recuperación o mejoría (OR 2,301; IC 95% 1,105–4,792; p = 0,026). La tasa de mortalidad hospitalaria fue del 41,5%.
Conclusiones: El tratamiento antimicrobiano empírico inapropiado fue frecuente en esta cohorte de UCI con una alta tasa de resistencia. La adherencia a las recomendaciones del programa de uso racional de antimicrobianos, en particular los ajustes basados en la Guía Sanford tras la disponibilidad de los resultados de susceptibilidad, se asoció con mejores desenlaces al alta en el análisis multivariable exploratorio. La terapia empírica adaptada localmente, combinada con una dosificación dirigida optimizada mediante PK/PD, debería evaluarse de forma prospectiva.
Palabras Clave: administración de antimicrobianos; cuidados críticos; pruebas de sensibilidad antimicrobiana; resistencia bacteriana a los medicamentos; resistencia bacteriana a múltiples medicamentos; resultado del tratamiento.
Citation Format: Dinh HTT, Pham KX, Nguyen AN (2026) Appropriateness of antibiotic therapy in sepsis patients in the intensive care unit: A single-center observational study. J Pharm Pharmacogn Res 13(3): 2799. https://doi.org/10.56499/jppres_14.3.2799
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