Implementation of Antibiotic Stewardship: A South Indian Experience (original) (raw)
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Hospital Ward Antibiotic Prescribing and the Risks of Clostridium difficile Infection
JAMA Internal Medicine, 2015
IMPORTANCE Only a portion of hospital-acquired Clostridium difficile infections can be traced back to source patients identified as having symptomatic disease. Antibiotic exposure is the main risk factor for C difficile infection for individual patients and is also associated with increased asymptomatic shedding. Contact with patients taking antibiotics within the same ward may be a transmission risk factor for C difficile infection, but this hypothesis has never been tested.
Infection Control and Hospital Epidemiology, 2014
OBJECTIVE. To determine whether controlling the prescription of targeted antibiotics would translate to a measurable reduction in hospital-onset Clostridium difficile infection (CDI) rates. DESIGN. A multicenter before-and-after intervention comparative study. SETTING/PARTICIPANTS. Ten medical centers in the greater New York region. Intervention group comprised of 6 facilities with early antimicrobial stewardship programs (ASPs). The 4 facilities without ASPs made up the nonintervention group. INTERVENTIONS/METHODS. Intervention facilities identified target antibiotics using case-control studies and implemented ASP-based strategies to control their use. Pre-and postintervention hospital-onset CDI rates and antibiotic consumption were compared for a 20month period from June 2010 to January 2012. Antibiotic usage was compared using defined daily dose, days of therapy, and number of courses prescribed. Comparisons used bivariate and regression techniques. RESULTS. Intervention facilities identified piperacillin/tazobactam, fluoroquinolones, or cefepime (odds ratio, 2.0-9.8 in CDI case patients compared with those without CDI) as intervention targets and selected several interventions (all included a component of audit and feedback). Varying degrees of success were observed in reducing antibiotic consumption over time. Total target antibiotic use significantly decreased (P < .05) when measured by days of therapy and number of courses but not by defined daily dose. Intravenous moxifloxacin and oral ciprofloxacin use showed significant reduction when measured by defined daily dose and days of therapy (P < .01). Number of courses with all forms of these antibiotics was reduced (P< .005). Intervention hospitals reported fewer hospital-onset CDI cases (2.8 rate point difference) compared with nonintervention hospitals; however, we were unable to show statistically significant decreases in aggregate hospital-onset CDI either between intervention and nonintervention groups or within the intervention group over time. CONCLUSIONS. Although decreases in target antibiotic consumption did not translate into reductions of hospital-onset CDI in this study, many valuable lessons (including implementation strategies and antibiotic consumption measures) were learned. The findings can inform potential policy decisions regarding incorporating control of CDI and ASP as healthcare quality measures.
RATIONALE OF ANTIBIOTIC PRESCRIPTION IN PATIENTS VISITING A TERTIARY CARE SOUTH INDIAN HOSPITAL
Asian Journal of Pharmaceutical and Clinical Research Journal, 2021
Objective: Antimicrobials are the class of drugs that are used irrationally in most cases leading to rise in instances of antimicrobial resistance altering the effect of such agents. Antimicrobial resistance has become a critical issue universally nerving the need to monitor the utilization pattern and rationality in prescribing of antibiotics. This helps in selection of most appropriate antibiotic for the specific patient and achieving the goals of the therapy. Methods: A prospective cross-sectional study with a sample size of 600 participants was conducted in department of general medicine of a tertiary care hospital. Inpatients prescribed with antibiotics were included in the study and their case sheets were reviewed to analyzing the prescribing pattern. The medication usage pattern was then assessed for rationality in prescribing was evaluated. The results obtained were statistically analyzed using SPSS Software. Results: It is noted that a more number of males participated and the greatest number of the patients were from the age group of 31-45. The diagnosis found in the majority of the patients was respiratory tract infection followed by others. On scrutinizing the prescriptions, it was noted that cephalosporins and penicillins were most often prescribed, and on an average single, antibiotic was frequently used with the preferred route of administration in most of the prescriptions being injection route. Though many of the antibiotics were prescribed empirically, it was observed that 59% of them were most appropriately dosed and maximum patients that are around 57% were cured from their illnesses. Conclusion: This study provided important baseline information on antimicrobial use within a large tertiary care teaching hospital and identified potential targets for future antimicrobial stewardship programs. The culture and sensitivity testing suggested that the drug resistance was more for most commonly prescribed antibiotics in the hospital. Increased targeted prescribing based on sensitivity tests will bring down the high use of empiric broad-spectrum antibiotic use.
Journal of Hospital Infection, 2003
We investigated whether a reduction in antibiotic use at the Aker University Hospital (Aker) led to a reduction in Clostridium difficile-associated diarrhoea (CDAD). We compared the incidence of CDAD in Aker and Tromsoe University Hospitals (Tromsoe) and related it to antibiotic use and facilities for infection control between 1993 -2001. For this purpose we also performed point prevalence studies. Total antibiotic use was the same in the two hospitals. In spite of a reduction in the use of broad-spectrum antibiotics in Aker the incidence of CDAD increased during 1993 -1999. In Tromsoe the use of broad-spectrum antibiotics and clindamycin was two to three times higher than in Aker, but until 1999 the incidence of CDAD remained constant and only half that of Aker. After 1999 the incidence of CDAD was halved in Aker, and increased three-fold in Tromsoe. Point prevalence studies in 2001 revealed an equal prevalence of antibiotic-associated diarrhoea. The facilities for infection control were better in Tromsoe. The percentage of single rooms were 8% in Aker and 14% in Tromsoe, and the percentage of single rooms with a WC was 6% in Aker and 12% in Tromsoe. The bed occupancy was much higher in Aker than in Tromsoe. Lack of facilities for infection control and higher bed occupancy could have contributed to the higher incidence of CDAD in Aker in spite of decreased use of broad-spectrum antibiotics and clindamycin. To limit CDAD in hospitals the focus must be on both rational antibiotic use and infection control.
Indian Journal of Critical Care Medicine
Patients admitted to the medical intensive care unit (MICU) of tertiary referral centers are critically ill and incidences of nosocomial infections are also very high. [1,2] Antibacterial agents are the most prescribed drugs for rapid control of serious infections to reduce the mortality and morbidity. [2-4] The burden of bacterial disease in India is among highest in the world and the inappropriate use of antibacterial agents leads to increase the development of antibacterial resistance. [1,5,6] Antibiotic resistance has been a low-priority area in most developing and many developed countries. To overcome the burden of infectious disease and rising antibiotic resistance prevalence in India, the Global Antibiotic Resistance Partnership-India Working Group have recommended important interventions which include surveillance of antibiotic use, distributing standard treatment guidelines, increasing the use of diagnostics tests, infection control interventions, educational approaches, and improving antibiotic supply chain and quality. [5] A drug utilization study is a potential tool which not only assesses the current prescribing pattern of drugs but also assess the disease burden as well resistance pattern of microorganisms and recommends necessary interventions to be used to achieve rational prescribing practice. [7] Resistance to important antibacterials such as vancomycin and colistin are increasing globally. [8,9] Majority of antibacterial
Audit of Antibiotic Practices: An Experience from a Tertiary Referral Centre
Indian Journal of Critical Care Medicine, 2019
Aims: To estimate the prevalence of antibiotic de-escalation at admission in patients referred to a tertiary hospital in India. The secondary outcomes were the adequacy of empirical antibiotic therapy and culture positivity rates in the de-escalated group. Materials and methods: A prospective observational study, in a 20-bedded ICU of tertiary care hospital. Patients> 18 years, surviving > 48 hours, were included (June-December 2017). Demographic data, previous cultures, and antibiotics from other hospitals, laboratory parameters in the first 24 hours, and severity of illness were noted. Changes made in antibiotic therapy within 48 hours were recorded. Patients were analyzed into three groups: "No change"-empiric therapy was maintained, "Escalation"-switch to or addition of an antibiotic with a broader spectrum, and "De-escalation"-switch to or interruption of a drug class. Results: The total number of patients eligible was 75. The mean age of the population is 43.38 (SD + 3.4) and groups were comparable in terms of mean SOFA and APACHE 2. The prevalence of de-escalation was 60% at admission. The escalation group consisted of 24%. Sixteen percent patients belonged to no change group. Results showed that 38% of patients were on Carbapenems, dual gram negative was given to 26%, and empirical MRSA coverage was 28% on admission. Conclusion: Our study aims to provide data about actual practices in the Indian scenario. It highlights the generous use of high-end antibiotics in the community. Indian practices are far cry from theoretical teaching and western data. The need for antibiotic stewardship program in our country for both public and private health sectors is the need of the hour.
Journal of Family Medicine and Primary Care, 2021
Background: Antimicrobial resistance (AMR) is a global concern requiring immediate attention. Among many proven measures of decreasing AMR, practice of antimicrobial stewardship is the lowest hanging which can be adapted with negligible financial implications. Methods: This is a case record based extended cross-sectional type of observational operation research study conducted at an institute of national importance established by Government of India. Point prevalence of antibiotic usage among the patients admitted in the hospital, on four different days in four different quarters of a year was done to study the impact of antimicrobial stewardship program (AMSP). Results: A cumulative 711 patients were exposed on antibiotics among 1396 study participants. There was a significant decrease in antibiotic consumption across the 1 st and 4 th quarter. The average antibiotic usage was 50.9% (61.75, 60%, 48.4%, and 39% respectively in the 1 st to 4 th quarter). Among the total number of patients, intravenous antibiotic usage was 47.9% (60.71%, 58.4%, 44.9%, and 34.2% respectively in 1 st to 4 th quarter). Among the newly admitted patients, the consumption of antibiotic usage decreased from 45.9% to 25.7%. Among the intravenous antibiotics, the top 10 consumed antibiotics were 3 rd generation cephalosporin (39.8%), aminoglycoside (14.8%), amoxicillin/amoxy-clav (12.5%), piperacillin-tazobactum (8.5%), carbapenams (6.6%), cefuroxime (6.4%), quinolones (4.3%), vancomycin/linezolid (4.1%), colistin (0.8%), and others (0.8%). Conclusion: Government run hospitals can run low budget antimicrobial stewardship program with sustainable impact on antibiotic consumption. For a successful AMSP, it requires change in attitude, commitment, and administrative support rather than a huge financial support.
Assessment of Antibiotic Use in a Secondary Care Referral Hospital of South India
IOSR Journal of Pharmacy and Biological Sciences, 2014
The emergence of antibiotic resistant bacteria is major problem throughout the world and rational use of antibiotics is therefore very important. Good infection control practice is a critical component for success of such programme. This six months prospective observational study was designed to evaluate the appropriateness of antibiotic use in a secondary care referral hospital of South India. The data of all in patients (n=100) were collected by obtaining a proper consent. Maximum of 52.78% patients had culture sensitivity test being done, which may taken as a indication for being rational. The results revealed that the purpose of antibiotics prescribed was for prophylaxis (15%), empirically (37%) and therapeutically 48%.In the study population (n=49), totally 110 antibiotics were prescribed, 71.88% on dual therapy and 28.12% were on three antibiotics and the mean number of antibiotics prescribed was 2.28. In the overall population, 61.65% were administrated intravenously and 39.35% of oral antibiotics The major organisms identified were E.coli (28.90%) and Amikacin had shown the highest sensitivity in E.coli (86.4%). Totally 31 drugs of antibacterials were listed in National List of Essential Medicine. Out of 31, 15 antibacterials were prescribed in study population.