Prospective audit and feedback on piperacillin/tazobactam use in a high-risk cardiac care unit: improving antibiotic stewardship

Background. Piperacillin/tazobactam (PT) is a widely used broad-spectrum antibiotic, especially in high-risk cardiac care settings. However, its inappropriate use contributes to antibiotic resistance and adverse patient outcomes. This study aimed to evaluate PT utilization patterns, assess prescribing appropriateness, and recommend improvements in antibiotic practices in a cardiac care setting in Karachi, Pakistan. Methods. A prospective audit was conducted over six months in a cardiac care unit. Data were collected on PT prescriptions, including patient demographics, indications, dosage, and duration. Each prescription was assessed for appropriateness according to established clinical guidelines. Feedback was provided to prescribing clinicians to optimize future PT use. Results. The audit revealed significant instances of inappropriate PT prescriptions, including unnecessarily prolonged therapy and use in patients without clear indications. Feedback and education led to improvements in prescribing practices, although further optimization remains necessary. Conclusion. This study highlights the importance of antimicrobial stewardship (AMS) in hospital settings, particularly for broad-spectrum agents like PT. The findings indicate that inappropriate antibiotic prescribing is prevalent and emphasize the need for robust AMS programs to promote rational use of antibiotics, prevent resistance, and improve patient outcomes. Future studies should focus on identifying the drivers of inappropriate prescribing and assessing the long-term effectiveness of AMS interventions.