Evaluation of Rational Antibiotic Use (RAU) in Cerebrovascular Accident (CVA) Patients in the ICU Using the Gyssens Criteria
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Fendy Prasetyawan*
Yuneka Saristiana
Lisa Savitri
Novyananda Salmasfattah
Tsamrotul Ilmi
Herman
Cerebrovascular accident (CVA) is a major cause of morbidity and mortality, often requiring intensive care unit (ICU) treatment. Patients with CVA are at high risk for secondary infections, which commonly lead to the use of antibiotics. This study aimed to evaluate the patterns and rationality of antibiotic use in CVA patients treated in the ICU of a regional hospital using the Gyssens method. A retrospective observational study was conducted involving 30 CVA patients who received antibiotics during their ICU stay. Data collected included patient demographics, comorbidities, types of antibiotics used, route of administration, combination patterns, and evaluation of prescription rationality based on the Gyssens criteria. The most frequently used antibiotic class was third-generation cephalosporins (60%), with ceftriaxone being the most prescribed (46.7%). All antibiotics were administered intravenously. Combination therapy was used in 20% of cases. Based on Gyssens categorization, only 33.3% of prescriptions were considered rational (category 0). The remaining 66.7% were irrational, including delayed initiation or discontinuation (13.3%), incorrect dosing (16.7%), unnecessarily broad-spectrum (10%), and no indication (6.7%). The study highlights a substantial proportion of irrational antibiotic use in ICU CVA patients, mainly due to suboptimal timing, dosing errors, and unnecessary broad-spectrum antibiotics. These findings underline the importance of antimicrobial stewardship and routine rationality assessments to ensure optimal antibiotic use and patient outcomes.
Alotaibi, B. A., Aldali, J. A., Aldali, H. J., Meo, S. A., Alasiri, G. A., Elsokkary, E. M., Alotaibi, N. D., & Alotaibi, F. (2023). The risk factors for acute cerebrovascular accident (stroke) in patients with severe acute respiratory syndrome coronavirus (SARS-CoV-2). Viruses, 15(5), 1140.
Anggraini, D., Haiga, Y., & Sjaaf, F. (2023). Risk Factors for Cerebrovascular Disease (Stroke) in Elderly. Scientific Journal, 2(1), 38–43.
Årdal, C., Baraldi, E., Busse, R., Castro, R., Ciabuschi, F., Cisneros, J. M., Gyssens, I. C., Harbarth, S., Kostyanev, T., & Lacotte, Y. (2024). Transferable exclusivity voucher: a flawed incentive to stimulate antibiotic innovation. The Lancet, 403(10422), e2–e4.
Azeem-ur-Rehman, M., Saddique, M. A., Bilal, M., Rauf, K., Jabeen, K., & Qureshi, Q. A. (2022). The frequency of stroke-acquired pneumonia in patients admitted to ICU with Cerebrovascular accident (CVA). Journal of Rawalpindi Medical College, 26(3).
Carval, T., Garret, C., Guillon, B., Lascarrou, J.-B., Martin, M., Lemarié, J., Dupeyrat, J., Seguin, A., Zambon, O., & Reignier, J. (2022). Outcomes of patients admitted to the ICU for acute stroke: a retrospective cohort. BMC Anesthesiology, 22(1), 235.
Chen, K.-Y., Chan, H.-C., & Chan, C.-M. (2025). Is there an association between retinal vein occlusion and cerebrovascular accident? A systematic review and meta-analysis. BMC Ophthalmology, 25(1), 112.
Fadrian, F., Aliska, G., & Utami, W. N. (2024). The relationship between appropriateness of antibiotic use based on the Gyssens algorithm and mortality: A retrospective cohort study in Indonesian tertiary hospital. Acta Medica Indonesiana, 56(2), 137–144.
Kollef, M. H., & Micek, S. T. (2014). Rational use of antibiotics in the ICU: balancing stewardship and clinical outcomes. Jama, 312(14), 1403–1404.
Limbong, Y. S., Khairunnisa, K., & Wiryanto, W. (2023). Evaluation of the use of antibiotics using the anatomical therapeutic chemical/defined daily dose and Gyssens methods in pneumonia patients at a tertiary care general hospital in Medan. International Journal of Basic & Clinical Pharmacology, 13(1), 13–21.
Masyrifah, M., Andrajati, R., & Yudhorini, L. T. (2022). Qualitative evaluation of antibiotics use with Gyssens method in sepsis patients at Fatmawati Central General Hospital Jakarta. Pharmaceutical Sciences and Research, 9(2), 2.
Mettler, J., Simcock, M., Sendi, P., Widmer, A. F., Bingisser, R., Battegay, M., Fluckiger, U., & Bassetti, S. (2007). Empirical use of antibiotics and adjustment of empirical antibiotic therapies in a university hospital: a prospective observational study. BMC Infectious Diseases, 7(1), 21.
Molly, P., Susanto, F. X. H., & Nugraha, D. P. (2023). Evaluasi Penggunaan Antibiotik Pada Pasien Icu Intensive Care Unit Di Rumah Sakit Mitra Sehat Dengan Metode Ddd Defined Daily Dose Dan Gyssens. Sainsbertek Jurnal Ilmiah Sains & Teknologi, 4(1), 24–31.
Nasidi, A. F. Al. (2024). Pengaruh Pemberian Antibiotik Dosis Tunggal Atau Kombinasi Terhadap Lama Perawatan Pasien Pneumonia Pada Anak (Studi Observasional Analitik Pada Anak Usia 6 bulan-5 tahun di RSI Sultan Agung Semarang Periode 2022-2023). Universitas Islam Sultan Agung Semarang.
Nelwan, E. J., Guterres, H., Pasaribu, A. I., Shakinah, S., Limato, R., & Widodo, D. (2021). The comparison of point prevalence survey (PPS) and Gyssens flowchart approach on antimicrobial use surveillance in Indonesian National Referral Hospital. Acta Medica Indonesiana, 53(4), 505.
Putri, F. F. (2024). Gambaran Perbandingan Kualitas Penggunaan Antibiotik Berdasarkan Algoritma Gyssens Pada Saat dan Setelah Pandemi COVID-19 di RSUP Dr. M. Djamil Padang. Universitas Andalas.
Putri, S. A., & Oktavilantika, D. M. (2023). Evaluasi Rasionalitas Penggunaan Antibiotik Pada Pasien Demam Tifoid Di Instalasi Rawat Inap Rumah Sakit “X” Indramayu Dengan Metode Gyssens. Jurnal Farmasi Dan Farmakoinformatika, 1(1), 1–13.
Rumende, C. M., Chen, L. K., Karuniawati, A., Bratanata, J., Falasiva, R., Sitorus, T. P., & Susanto, E. C (2019). Correlation between Proper Antibiotics Administration to Community Acquired Pneumonia Patients Based on Alur Gyssens with Clinical Response. Jurnal Penyakit Dalam Indonesia, 6(2), 4. https://doi.org/10.7454/jpdi.v6i2.335
Rohmah, S. D., Andrajati, R., & Yudhorini, L. T. (2023). Qualitative evaluation of antibiotic use in bacterial meningitis patients using the Gyssens method. Jurnal Aisyah: Jurnal Ilmu Kesehatan, 8(S1), 169–178.
Su, X., Sun, L., Sun, X., & Zhao, Q. (2024). Machine learning for predicting device associated infection and 30 day survival outcomes after invasive device procedure in intensive care unit patients. Scientific Reports, 14, Article 23726. https://doi.org/10.1038/s41598-024-74585-0
Suminar, F. D. (2022). Rationality Evaluation of Antibiotic Use In Pediatric Pneumonia At Hospitals In Indonesia. Pharmacology, Medical Reports, Orthopedic, and Illness Details (COMORBID), 1(2), 27–40. https://doi.org/https://doi.org/10.55047/comorbid.v1i2.122
Vincent, J. L., Rello, J., Marshall, J., Silva, E., Anzueto, A., Martin, C. D., Moreno, R., Lipman, J., Gomersall, C., Sakr, Y., Reinhart, K., & EPIC II Investigators. (2009). International study of the prevalence and outcomes of infection in intensive care units (EPIC II). JAMA, 302(21), 2323–2329. https://doi.org/10.1001/jama.2009.1754
Wibowo, S. N., Budisulistyo, T., Sunarsih, E. S., & Nindita, Y. (2021). Evaluation Of Antibiotic Usage In Iskemic Stroke Patients With Infections In Rsup Dr. Kariadi Semarang Period 2018. Jurnal Kedokteran Diponegoro (Diponegoro Medical Journal), 10(3), 189-193. https://doi.org/10.14710/dmj.v10i3.30137
Zhu, H., Liang, W., Zhu, J., He, X., Zou, P., Yang, K., Li, G., Liao, B., Deng, H., Liang, Z., Zhao, J., Zhao, Z., Chen, J., He, Q., & Ning, W. (2024). Nomogram to predict ventilator associated pneumonia in large vessel occlusion stroke after endovascular treatment: A retrospective study. Frontiers in Neurology, 15, Article 1351458. https://doi.org/10.3389/fneur.2024.1351458
