Perspectives of ICU Physicians on Antibiotic Use in Critically Ill Patients: A Qualitative Study from a Developing Country
Objective: To explore the experiences and perceptions of ICU consultants regarding antibiotic prescribing practices in critically ill patients within resource-limited healthcare settings. Method: This qualitative study, based on a phenomenological approach, was conducted between January 1 and Dec...
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University of Lahore
2025-06-01
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| Series: | Journal of University College of Medicine and Dentistry |
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| Online Access: | https://journals.uol.edu.pk/jucmd/article/view/4102 |
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| author | Maheen Khoso Arshad Taqi Muhammad Aamir Alsabah Faisal Imran Naveed Latif |
| author_facet | Maheen Khoso Arshad Taqi Muhammad Aamir Alsabah Faisal Imran Naveed Latif |
| author_sort | Maheen Khoso |
| collection | DOAJ |
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Objective: To explore the experiences and perceptions of ICU consultants regarding antibiotic prescribing practices in critically ill patients within resource-limited healthcare settings.
Method: This qualitative study, based on a phenomenological approach, was conducted between January 1 and December 30, 2023, at the National Hospital & Medical Center and DHA Medical Center, Lahore, Pakistan. Six ICU consultants with more than two years of post-fellowship experience were recruited through purposive sampling. Data were collected via face-to-face, semi-structured interviews, audio-recorded with consent. Thematic analysis was performed until data saturation was achieved.
Results: Six major themes emerged. First, early initiation of antibiotics without confirmed diagnosis was reported as a routine and often necessary practice due to diagnostic uncertainty and delays in culture results. Second, barriers to antimicrobial stewardship (AMS) were noted, including the absence of formal AMS policies, poor interdepartmental coordination, and limited access to antibiograms—particularly in government hospitals. Third, factors influencing antibiotic selection included infection site, comorbidities, and family pressure, with variation between open and closed ICU models. Fourth, pharmaceutical incentives were largely deemed irrelevant in ICU prescribing due to the critical nature of decisions. Fifth, inflammatory markers like CRP and procalcitonin were valued for guiding antibiotic de-escalation, though high cost limited routine use. Finally, all participants expressed concern over the rise of antimicrobial resistance (AMR), highlighting the need for better microbiology infrastructure, public education, and regulated antibiotic access.
Conclusion: ICU antibiotic prescribing is shaped by clinical urgency, systemic limitations, and contextual pressures. To mitigate the threat of AMR in low-resource settings, it is crucial to strengthen AMS programs, expand diagnostic capacity, and enforce locally adaptable prescribing protocols.
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| format | Article |
| id | doaj-art-e075e86a135449e898efe5559403054f |
| institution | Kabale University |
| issn | 2790-3443 2790-3451 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | University of Lahore |
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| series | Journal of University College of Medicine and Dentistry |
| spelling | doaj-art-e075e86a135449e898efe5559403054f2025-08-20T03:27:15ZengUniversity of LahoreJournal of University College of Medicine and Dentistry2790-34432790-34512025-06-014210.51846/jucmd.v4i2.4102Perspectives of ICU Physicians on Antibiotic Use in Critically Ill Patients: A Qualitative Study from a Developing CountryMaheen Khoso0Arshad Taqi1Muhammad Aamir Alsabah2Faisal Imran3Naveed Latif4Consultant Critical Care, National Hospital and Medical Centre, Lahore, PakistanConsultant Critical Care, National Hospital and Medical Centre, Lahore, Pakistan Consultant Critical Care, National Hospital and Medical Centre, Lahore, Pakistan Consultant Anesthetist, National Hospital and Medical Centre, Lahore, Pakistan Consultant Anesthetist, National Hospital and Medical Centre, Lahore Objective: To explore the experiences and perceptions of ICU consultants regarding antibiotic prescribing practices in critically ill patients within resource-limited healthcare settings. Method: This qualitative study, based on a phenomenological approach, was conducted between January 1 and December 30, 2023, at the National Hospital & Medical Center and DHA Medical Center, Lahore, Pakistan. Six ICU consultants with more than two years of post-fellowship experience were recruited through purposive sampling. Data were collected via face-to-face, semi-structured interviews, audio-recorded with consent. Thematic analysis was performed until data saturation was achieved. Results: Six major themes emerged. First, early initiation of antibiotics without confirmed diagnosis was reported as a routine and often necessary practice due to diagnostic uncertainty and delays in culture results. Second, barriers to antimicrobial stewardship (AMS) were noted, including the absence of formal AMS policies, poor interdepartmental coordination, and limited access to antibiograms—particularly in government hospitals. Third, factors influencing antibiotic selection included infection site, comorbidities, and family pressure, with variation between open and closed ICU models. Fourth, pharmaceutical incentives were largely deemed irrelevant in ICU prescribing due to the critical nature of decisions. Fifth, inflammatory markers like CRP and procalcitonin were valued for guiding antibiotic de-escalation, though high cost limited routine use. Finally, all participants expressed concern over the rise of antimicrobial resistance (AMR), highlighting the need for better microbiology infrastructure, public education, and regulated antibiotic access. Conclusion: ICU antibiotic prescribing is shaped by clinical urgency, systemic limitations, and contextual pressures. To mitigate the threat of AMR in low-resource settings, it is crucial to strengthen AMS programs, expand diagnostic capacity, and enforce locally adaptable prescribing protocols. https://journals.uol.edu.pk/jucmd/article/view/4102Antibiotic PrescribingAntimicrobial ResistanceAntimicrobial StewardshipCritically Ill PatientsICU |
| spellingShingle | Maheen Khoso Arshad Taqi Muhammad Aamir Alsabah Faisal Imran Naveed Latif Perspectives of ICU Physicians on Antibiotic Use in Critically Ill Patients: A Qualitative Study from a Developing Country Journal of University College of Medicine and Dentistry Antibiotic Prescribing Antimicrobial Resistance Antimicrobial Stewardship Critically Ill Patients ICU |
| title | Perspectives of ICU Physicians on Antibiotic Use in Critically Ill Patients: A Qualitative Study from a Developing Country |
| title_full | Perspectives of ICU Physicians on Antibiotic Use in Critically Ill Patients: A Qualitative Study from a Developing Country |
| title_fullStr | Perspectives of ICU Physicians on Antibiotic Use in Critically Ill Patients: A Qualitative Study from a Developing Country |
| title_full_unstemmed | Perspectives of ICU Physicians on Antibiotic Use in Critically Ill Patients: A Qualitative Study from a Developing Country |
| title_short | Perspectives of ICU Physicians on Antibiotic Use in Critically Ill Patients: A Qualitative Study from a Developing Country |
| title_sort | perspectives of icu physicians on antibiotic use in critically ill patients a qualitative study from a developing country |
| topic | Antibiotic Prescribing Antimicrobial Resistance Antimicrobial Stewardship Critically Ill Patients ICU |
| url | https://journals.uol.edu.pk/jucmd/article/view/4102 |
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