Abbreviations: IQR: interquartile range
A BLA was documented on 52.1% (n=25) of the inpatient prescription charts, with significantly higher rates of documentation in the privately-funded facilities (n=9, 81.8%) as compared to the government-funded facilities (n=16, 43.2%) (p=0.02) (Table 4 ,Supplement Table 3 ). A total of 34 (71%) of the reported BLA patients were prescribed antibiotics, of which 22 (64.7%) still received a beta-lactam containing antibiotic: Beta-lactam / beta-lactamase inhibitor combination (amoxicillin-clavulanate or Piperacillin-tazobactam) n= 6; Aminopenicillin n=5; Cephalosporins n=9; Carbapenem n=2.
The 11 patients (32.4%) that were prescribed a beta-lactam / aminopenicillin, either alone or in combination with clavulanate, completed treatment with no subsequent allergic reaction. Seven of these patients who received a beta-lactam / aminopenicillin had no documentation of the reported BLA in the prescription charts or patient notes. Ten of these 11 patients were classified as low risk by PEN-FAST scoring; however one patient’s risk was high with previous anaphylaxis and laryngeal angioedema. The remaining 14 (41.2%) patients were prescribed: Lincosamides n=5; Aminoglycosides n=3; Fluoroquinolones/ quinolones n=2; Macrolides n=2; and Nitroimidazole n=1.
Over a quarter of the patients were prescribed more than one antibiotic. As per antibiotic stewardship requirements 15 (44.1%) patients had the indication for the antibiotic documented on the antibiotic chart. The difference between the government funded and privately funded hospitals was not significant (p=0.1): n=10 [37%] in the government funded hospitals and n=5 [71.4%] in the privately funded hospitals. The most common indication for antibiotic therapy was pneumonia (n=4), followed by bloodstream infection (n=2), and finally gynecological/obstetric, urinary tract infection, and abdominal infection (n=1 respectively). In five patients the indication for an antibiotic was documented as “not defined”.