A Study on Appropriateness of Antibacterial Use in Acute Wards of a Teaching Hospital
Abstract
Objective: A study to analyse the appropriateness of use of antibacterials in acute wards of a tertiary care hospital. Design: A pharmacoepidemiological research study. Intervention: Non-interventional descriptive study. Main Outcome Measure: The antibacterial prescriptions were analyzed for their adherence to or deviation from the standard national treatment guidelines. Results: There were a total of 207 patients comprising of 35 in acute medical ward, 65 in ICU, 53 in acute surgical ward and 54 in family ward, who were prescribed antibacterials. These consisted of a total of 383 prescription counts for appropriateness of AMA use. One third of the antibacterial prescriptions of inpatients surveyed were for prophylactic use followed by the treatment of respiratory and gastrointestinal diseases. The highest prescription counts were seen with carbapenems followed by nitroimidazoles, cephalosporins, aminoglycosides and penicillins. 99% of the prescriptions were appropriate for the dose used and 49.6% of the prescriptions were inappropriate for duration of use. 74.5% of the surgical prophylaxis prescriptions were used for more than 24 hours. Ceftriaxone and cefotaxime were used instead of the recommended cefazolin, for prophylaxis. High percentage of deviation was observed with prescriptions of cefotaxime and metronidazole for empirical use. No definitive use of antimicrobials for infections was observed in the ICU. Conclusion: A high percentage of appropriateness was observed for dose of antibiotic used. The main targets identified for improvement are duration of antimicrobial use, choice of drug for surgical prophylaxis and the definitive use of antimicrobial agents.
Keywords: adherence to treatment guidelines, antibiotic audit, antimicrobials.
Keywords:
adherence to treatment guidelines, antibiotic audit, antimicrobialsDOI
https://doi.org/10.22270/jddt.v10i1-s.3927References
Malcolm W, Nathwani D, Davey P, Cromwell T, Patton A, Reilly J, et al. From intermittent antibiotic point prevalence surveys to quality improvement: experience in Scottish hospitals. AntimicrobResist Infect Control. 2013; 2(1):3.
World Health Organization Model List of Essential Medicines, 21st List, 2019. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO.
Holloway KA, Rosella L, Henry D. The impact of WHO essential medicines policies on inappropriate use of antibiotics. PLoS One. 2016 Mar 22; 11(3):e0152020.
Indian Council of Medical Research (ICMR). Treatment Guidelines for Antimicrobial Use in Common Syndromes. ICMR, Department of Health Research, New Delhi, India; 2017. [cited 15 May 2019]Available from: https://www.icmr.nic.in/sites/default/files/guidelines/treatment_guidelines_for_antimicrobial.pdf.
Sikkens JJ, Van Agtmael MA, Peters EJ, Lettinga KD, Van Der Kuip M, Vandenbroucke-Grauls CM, et al. Behavioral approach to appropriate antimicrobial prescribing in hospitals: the Dutch Unique Method for Antimicrobial Stewardship (DUMAS) participatory intervention study. JAMA Intern Med. 2017; 177(8):1130-8.
Ansari F, Erntell M, Goossens H, Davey P, ESAC II Hospital Care Study Group. The European surveillance of antimicrobial consumption (ESAC) point-prevalence survey of antibacterial use in 20 European hospitals in 2006. Clin Infect Dis. 2009; 49(10):1496-504.
Cotta MO, Robertson MS, Upjohn LM, Marshall C, Liew D, Buising KL. Using periodic point‐prevalence surveys to assess appropriateness of antimicrobial prescribing in Australian private hospitals. Intern Med J. 2014; 44(3):240-6.
James R, Upjohn L, Cotta M, Luu S, Marshall C, Buising K, Thursky K. Measuring antimicrobial prescribing quality in Australian hospitals: development and evaluation of a national antimicrobial prescribing survey tool. J Antimicrob Chemother. 2015; 70(6):1912-8.
Pathak A, Mahadik K, Dhaneria SP, Sharma A, Eriksson B, Lundborg CS. Surveillance of antibiotic consumption using the “focus of infection” approach in 2 hospitals in Ujjain, India. PLoS One. 2012; 7(6):e38641.
Ansari F, Erntell M, Goossens H, Davey P, ESAC II Hospital Care Study Group. The European surveillance of antimicrobial consumption (ESAC) point-prevalence survey of antibacterial use in 20 European hospitals in 2006. Clin Infect Dis. 2009; 49(10):1496-504.
Tallman GB, Vilches-Tran RA, Elman MR, Bearden DT, Taylor JE, Gorman PN, et al. Empiric antibiotic prescribing decisions among medical residents: the role of the antibiogram. Infection Control &Hospital Epidemiology. 2018; 39(5):578-83.
van den Bosch CM, Geerlings SE, Natsch S, Prins JM, Hulscher ME. Quality indicators to measure appropriate antibiotic use in hospitalized adults. Clinical Infectious Diseases. 2014; 60(2):281-91.
Akhloufi H, Streefkerk RH, Melles DC, de Steenwinkel JE, Schurink CA, Verkooijen RP, van der Hoeven CP, Verbon A. Point prevalence of appropriate antimicrobial therapy in a Dutch university hospital. Eur JClin Microbiol Infect Dis. 2015; 34(8):1631-7.
Ingram PR, Seet JM, Budgeon CA, Murray R. Point‐prevalence study of inappropriate antibiotic use at a tertiary Australian hospital. Intern Med J. 2012; 42(6):719-21.
Shah N, Joshi A, Ganguly B. Impact of antibiotic stewardship program on prescribing pattern of antimicrobials in patients of medical intensive care unit. Journal of clinical and diagnostic research: JClin Diagn Res. 2017; 11(7):FC11-FC15.
Hecker MT, Aron DC, Patel NP, Lehmann MK, Donskey CJ. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med. 2003; 163(8):972-8.
Willemsen I, Groenhuijzen A, Bogaers D, Stuurman A, van Keulen P, Kluytmans J. Appropriateness of antimicrobial therapy measured by repeated prevalence surveys. Antimicrob Agents Chemother. 2007; 51(3):864-7.
Kaur A, Bhagat R, Kaur N, Shafiq N, Gautam V, Malhotra S, Suri V, Bhalla A. A study of antibiotic prescription pattern in patients referred to tertiary care center in Northern India. Ther Adv Infect Dis. 2018; 5(4):63-8.
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