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RESEARCH LETTER
Year : 2021  |  Volume : 12  |  Issue : 1  |  Page : 20-22
 

Antibacterial use in admitted patients of a super speciality hospital in Western India


Department of Pharmacology, Armed Forces Medical College, Pune, Maharashtra, India

Date of Submission20-Nov-2020
Date of Decision28-Jan-2021
Date of Acceptance10-Feb-2021
Date of Web Publication05-Jul-2021

Correspondence Address:
Sanjay Jaiswal
Department of Pharmacology, Armed Forces Medical College, Pune - 411 040, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpp.JPP_156_20

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How to cite this article:
Shyam S, Jaiswal S. Antibacterial use in admitted patients of a super speciality hospital in Western India. J Pharmacol Pharmacother 2021;12:20-2

How to cite this URL:
Shyam S, Jaiswal S. Antibacterial use in admitted patients of a super speciality hospital in Western India. J Pharmacol Pharmacother [serial online] 2021 [cited 2021 Aug 2];12:20-2. Available from: http://www.jpharmacol.com/text.asp?2021/12/1/20/320713




Sir,

Antimicrobial agents (AMA) are one of the most widely prescribed drugs in hospitals. The general perception is that super specialty hospitals have high prescribing trends of AMA, adding to the cost of the treatment and burden of antimicrobial resistance.[1] Hence, it was worth studying the trend of AMA use in a super specialty hospital in Western India. In this context, a point prevalence survey (PPS) was carried out on a single day, in the month of January 2019, at a 600-bedded super specialty hospital. Ethical clearance was obtained from the Institutional Ethics Committee before conduct of the survey.

The PPS was adapted from the European Center for Disease Control guidelines.[2] The survey was carried out to include all patients in the hospital wards and those who were prescribed with antibacterial agents for more than a day. Those on chronic treatment with anti-tubercular drugs or chemoprophylaxis for repeated urinary tract infections were excluded from the study. The data were obtained from the case sheets and the inpatient hospital record forms. Wards included were intensive coronary care unit, cardiothoracic-vascular surgery intensive care unit (ICU), respiratory ICU, cardiology, respiratory, and oncology. A total of 107 patients were surveyed. Among them, 47 patients were found to be prescribed with antibiotics on the day of the survey (43.9%). More than 60% of the patients surveyed were above the age of 50 years. Of these inpatients, 41 were male (87.2%). The system wise diagnoses of patients prescribed AMA and combination antimicrobials are tabulated in [Table 1]A and [Table 1]B, respectively. On the day of survey, a total of 12 samples (sputum-4, urine-4, blood-2, cerebrospinal fluid, and wound swab – 1 each), were sent to the laboratory for bacterial culture and antibiotic sensitivity. All 12 of the clinical samples did not show bacterial growth on culture. The antibiotics prescribed to the 47 patients were hence empirical and not definitive. In our study, clinical specimens for the pathogen identification were sent to the laboratory for only around 25% of the patients prescribed empirical antimicrobial therapy. As per the guidelines, clinical specimens should always be sent for microbial culture before starting with AMA. Further, with no isolation of pathogens in any of the empirical use of antimicrobials, a detailed antibiotic prescription analysis and clinical audit by the hospital infection committee is a felt need [Figure 1] depicts the distribution of AMA prescriptions according to antibiotic classes (total 77 prescription counts). The injectable AMA comprised 55.8% of the total AMA prescribed on the day of PPS. Twenty patients were prescribed more than one AMA. Eight of these patients (40%) were prescribed antibiotics for surgical prophylaxis and 35% for lower respiratory tract infection (LRTI). The usage of combination antimicrobials has been highlighted in [Table 1]B. This usage is in conformity to the Indian Council of Medical Research (ICMR) guidelines in 9 out of 20 total cases.
Table 1: Antimicrobial agents prescribed on day of point prevalence survey

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Figure 1: Pattern of antimicrobial agents usage on day of point prevalence survey

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PPS is an effective method to study antibiotic prevalence and consumption in any health-care institution (HCI). In a snapshot study at the HCI, the adherence to national or regional antibiotic policy can be commented upon. This is important and needs to be carried out periodically to prevent overuse or misuse of AMA to prevent the emergence of antibiotic resistance. The World Health Organization (WHO) has grouped the antimicrobials into Access, Watch, and Reserve classes, which should be adhered to, as far as possible.[3] The WHO model list of essential medicines safeguards against rampant use of AMA, especially as the empirical treatment of infections. The third-generation cephalosporins, macrolides, and quinolones have been placed in the Watch group, whereas carbapenems form the Reserve group of AMA.[3] The highest consumption of AMA in our study was for surgical prophylaxis and of 3rd-generation cephalosporins (prescription counts of cefotaxime and cefuroxime– 6 each, cefoperazone– 4 and ceftriaxone-1). The recommendation for surgical prophylaxis of clean wounds is no AMA at all or a single dose of cefazolin/cefuroxime.[4] A need is, therefore, felt to improve the hospital infection control practices to avoid the use of preoperative AMA prophylaxis. In any case, cefazolin and cefalexin, being Access group of anti-infectives, should be encouraged as empirical AMA therapy.[3]

Respiratory tract infections are still a cause of concern in both well to do and developing nations. In fact, lower respiratory infections and tuberculosis figure as the 5th and 6th most common cause of death in India.[5] The ICMR recommends ceftriaxone/cefotaxime/amoxycillin-clavulanic acid/piperacillin-tazobactam along with macrolide/doxycycline and avoiding fluoroquinolones, as empirical therapy for hospitalized patients suspected of community acquired pneumonia.[4] Use of fluoroquinolones as empirical therapy in our patients of LRTI needs re-assessment of treatment protocols in the hospital.

The PPS carried out by us in a super-specialty hospital emphasizes the need to optimize the use of antibacterial, especially as preoperative prophylaxis and choice of empirical therapy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Wattal C, Khanna S, Goel N, Oberoi JK, Rao BK. Antimicrobial prescribing patterns of surgical speciality in a tertiary care hospital in India: Role of persuasive intervention for changing antibiotic prescription behaviour. Indian J Med Microbiol 2017;35:369-75.  Back to cited text no. 1
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2.
European Centre for Disease Prevention and Control. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals – ECDC PPS validation version 3.1.2. Stockholm: ECDC; 2019.  Back to cited text no. 2
    
3.
World Health Organization Model List of Essential Medicines, 21st List, 2019. Geneva: World Health Organization; 2019.  Back to cited text no. 3
    
4.
Indian Council of Medical Research. Treatment Guidelines of Antimicrobial use in Common syndromes. 2nd ed. New Delhi: ICMR; 2019.  Back to cited text no. 4
    
5.
Centers for disease control and prevention. Global health – India. India top 10 causes of death, source: GBD compare 2018, India; 2020. Available from: https://www.cdc.gov/globalhealth/countries/india/default.htm. [Last accessed on 2020 Nov 20].  Back to cited text no. 5
    


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