RESUMO
OBJECTIVE: The aims of this study were to evaluate the use of antimicrobial agents in the fever wards of a Hong Kong teaching hospital and to identify those factors associated with treatment failure and having an influence on the total direct medical costs of antimicrobial therapy. METHODS: This was a retrospective observational study. Demographic and clinical data were collected on 123 patients admitted to the fever wards in a local teaching hospital between July 2004 and August 2004. Multivariate analyses were performed to identify factors associated with treatment failure and the total direct medical treatment cost. RESULTS: The rate of treatment failure was 30.1% (37 out of 123 patients). The mean total direct medical cost was HK$ 26,442 +/- 17,153 (US$ 1 = HK$ 7.8). The empirical therapy in 90 (73.2%) patients complied with the institutional guidelines. 25 (20.3%) patients were eligible for renal dosage adjustment and in 7 (28%) of these patients the dosage of antimicrobial agents was renally adjusted. Of the 27 patients in whom pathogens were identified, 9 (33.3%) patients were eligible for antimicrobial streamlining (changing to an antibiotic with a narrower spectrum) but streamlining was only done in 2 (22.2%) patients. Multivariate analysis showed that the history of malignant diseases (RR = 5.07; 95% CI = 1.06 - 24.22) and non-compliance with the institutional treatment guidelines for selection of empirical antimicrobial therapy (RR = 3.58; 95% CI = 1.35 - 9.54) were risk factors associated with treatment failure. Duration of intravenous antimicrobial therapy was associated with the total cost of treatment (RR = 1.60; 95% CI = 1.35 - 2.10). CONCLUSION: Non-compliance with treatment guidelines in empirical antimicrobial treatment and the duration of intravenous antimicrobial therapy were modifiable risk factors for treatment failure and total treatment cost, respectively.