Empiric gram-negative antibiotics usage among critically ill patients across 13 ICUs of Nepal: A retrospective cohort study

This retrospective cohort study examined the use of empiric gram-negative antibiotics among critically ill patients in 13 ICUs across Nepal from January 2020 to December 2022. The study focused on adult patients who received broad-spectrum gram-negative antimicrobials within the first two days of ICU admission without confirmed infection. Among 12,349 eligible patients, 70.6% received empiric gram-negative antibiotics, with 62.8% of these receiving broad-spectrum antibiotics. Patients given broad-spectrum antibiotics were generally older and exhibited higher heart rates, respiratory rates, inspired oxygen fractions, blood sugar levels, total leucocyte counts, and serum creatinine, alongside lower systolic blood pressure, partial pressure of oxygen, and pH levels. The study identified readmission, cardiac support, and mechanical ventilation as factors increasing the likelihood of broad-spectrum antibiotic use. The findings highlight the significant use of broad-spectrum antibiotics in Nepalese ICUs and underscore the need for antimicrobial stewardship programs to manage antibiotic administration effectively and combat antimicrobial resistance.