Recent Prescribing Trends of Anti- Microbial Agents and their Sensitivity Pattern in an Intensive Care Unit of a Tertiary Care Teaching Hospital
Background: Due to the injudicious and indiscriminate use of Anti-Microbial Agents (AMAs) among hospitalized patients especially in ICUs, it is extremely imperative to monitor and refine the prescribing pattern of antibiotics regularly. Hence an effective surveillance team consisting of a physician, a pharmacologist and a microbiologist should develop and implement an antimicrobial stewardship program based on the local antibiogam to increase the therapeutic benefits and curb the menace of Anti-Microbial Resistance (AMR). Aims:-To study the prescribing pattern of Anti-Microbial Agents and to evaluate the antimicrobial sensitivity pattern of common bacterial isolates in Medical ICU (MICU) of a tertiary care hospital. Methods: After taking approval from the Institutional ethical committee, this prospective observational study was conducted in the department of Pharmacology and Microbiology over a period of six months. Patient records were reviewed and analyzed to assess the prescribing pattern of antibiotics and Culture-sensitivity reports of various specimen from MICU were collected to determine the antibiotic sensitivity pattern. Results: Ceftriaxone (26%) was the most commonly prescribed drug followed by Metronidazole (16%). Fixed drug combinations such as Piperacillin+Tazobactam (14%), Amoxicillin + clavulanic acid (10%) and Cefoperazone + Sulbactam (8%) were also frequently used. The most predominant organism isolated was Klebseilla species (25%) followed by Acenitobacter species (19.4%). Colistin /Imipenem and Vancomycin/Linezolid depicted100% sensitivity for Gram-Negative (GNIs) and Gram-Positive Isolates (GPIs) respectively. Conclusions: The need of the hour is to preserve the power of the almost exhausted antimicrobial armamentarium against the rampantly emerging multidrug resistant organisms.
2. Cantas L, Shah SQ, Cavaco LM, Manaia CM, Walsh F, Popowska M, et al. A brief multi-disciplinary review on antimicrobial resistance in medicine and its linkage to the global environmental microbiota. Front Microbiol. 2013; 4: 96. doi:10.3389/fmicb.2013.00096
3. Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, et al. Antibiotic resistance-the need for global solutions. Lancet Infect Dis. 2013; 13(12):1057–98. doi:10.1016/S1473-3099(13)70318-9.
4. Pollack LA, Srinivasan A. Core elements of hospital antibiotic stewardship programs from the Centers for Disease Control and Prevention. Clin Infect Dis. 2014; 59 Suppl 3:S97–100. doi:10.1093/cid/ciu542.
5. Barber M, Rozwadowska-Dowzenko M. Infection by penicillin-resistant staphylococci. Lancet. 1948;2(6530):641–4.
6. English BK, Gaur AH: The use and abuse of antibiotics and the developmentof antibiotic resistance. In: Hot Topics in Infection and Immunity in Children VI. edn. New York: Springer International Publishing AG; 2010: p. 73–82.
7. Okeke IN, Klugman KP, Bhutta ZA, Duse AG, Jenkins P, O'Brien TF, et al. Antimicrobial resistance in developing countries. Part II: strategies for containment. Lancet Infect Dis. 2005; 5(9):568–80. doi:10.1016/S1473-3099(05)70217-6.
8. Čižman M. The use and resistance to antibiotics in the community. Int J Antimicrob Agents. 2003; 21(4):297–307.
9. Valles J, Ferrer R. Blood stream infection in the ICU. Infect DisClin N Am. 2009; 23:557–69.2
10. Lisha JJ, Padmini D, Jenny J, Shoba G. Drug Utilization Study of Antimicrobial agents in Medical intensive care unit of a tertiary care hospital. Asian J Pharm Clin Res.2011; 4(2):81-4.
11. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2095‑128
12. Marwick C, Davey P. Care bundles: The holy grail of infectious risk management in hospital? Curr Opin Infect Dis 2009; 22:364‑9.
13. Pandiamunian J, Somasundaram G, Manimekalai K, Kartik JS. A study on prescribing pattern of drugs by general practitioners in a rural area of Tamilnadu. Int J Pharm Bio Sci 2013 Apr; 4(2): 480-6
14. Vandana AB, Sanjaykumar BN. Study of prescribing pattern of antimicrobial agents in medicine intensive care unit of a teaching hospital in central india. japi. 2012 april; 60:20-3
15. Drupad HS, Nagabushan H and Prakash GM Prospective and observational study of antimicrobial drug utilization in medical intensive care unit in a tertiary care teaching hospital International Journal of Pharmacological Research IJPR Volume 6 Issue 01 (2016) :13-17
16. Shankar PR, Partha P, Shenoy NK, Easow JM, Brahmadathan KN. Prescribing patterns of antibiotics and sensitivity patterns of common microorganisms in the Internal Medicine ward of a teaching hospital in Western Nepal: a prospective study. Ann Clin Microbiol Antimicrob.2003 Jul 16; 2:7
17. Choudhury D, Deka A, Roy D. Pattern of Antibiotics Used in the Pediatrics Indoor Department at Silchar Medical College and Hospital, Assam, India. Sch J App Med Sci. 2015; 3(4C):1810-4.
18. Muhammad Atif, Muhammad Azeem1, Anum Saqib1 and Shane Scahill2 Investigation of antimicrobial use at a tertiary care hospital
in Southern Punjab. Pakistan using WHO methodology, BioMed Central (2017) 6:41
19. Ahmad A, Revanker M, Haque I, Pravina A, Ivan R, Dasari R, et al. Study the Prescription Pattern of Antibiotics in the Medicine Department in a Teaching Hospital: A Descriptive Study International Journal of Toxicological and Pharmacological Research. 2014; 6(2):43-6.
20. Patel MK, Barvaliya MJ, Patel TK, Tripathi C. Drug utilization pattern in critical care unit in a tertiary care teaching hospital in India. Int J Crit Illn Inj Sci.2013 Oct;3(4): 250-5
21. Beg MA, Bawa S, Dutta S, Anjoom M, and Vishal S. Study of antimicrobial Prescribing pattern in a tertiary care teaching hospital at Dehradun, Uttarakhand, India - A tool to teach clinical pharmacology to MBBS students. Int J Basic Clin Pharmacol 2016; 5:2444-8
22. Gudapati Bhanu Naga Sireesha, Pramil Tiwari, Satinder Gombar1, Sanjay D’Cruz2, Atul Sachdev2 Antimicrobial utilization in multidisciplinary intensive care units of a public tertiary care hospital Journal of Pharmacology and Pharmacotherapeutics | October-December 2014 | Vol 5 | Issue 4: 252-254.
23. Devi V, Sahoo B, Damrolien S, Praveen S, Lungran P, Devi M. A study on the bacterial profile of bloodstream infections in Rims Hospital. J Dent Med Sci 2015; 14:18‑23.
24. Garg A, Anupurba S, Garg J, Goyal RK, Sen MR. Bacteriological profile and antimicrobial resistance of blood culture isolates from a university hospital. J Indian Acad Clin Med 2007;8:139‑43.
25. Ghanshani R, Gupta R, Gupta BS, Kalra S, Khedar RS, Sood S. Epidemiological study of prevalence, determinants, and outcomes of infections in medical ICU at a tertiary care hospital in India. Lung India 2015;32:441-8.
26. Chand Wattal, Reena Raveendran, Neeraj Goel, Jaswinder Kaur Oberoi ,Brijendra .Ecology of blood stream infection and antibiotic resistance inintensive care unit at a tertiary care hospital in North India, braz j infect dis . 2014;18(3):245–251
27. Anurag Ambroz Singh et al. Prevalence of microbial infection and strategic pattern of antimicrobial resistance among intensive care unit patients in a tertiary care teaching hospital from rural Northern India; International Archives of Integrated Medicine, Vol 2 Issue 3,March, 2015.
28. Gupta S, Kashyap B. Bacteriological profile and antibiogram of blood culture isolates from a tertiary care hospital of North India. Trop J Med Res 2016;19:94-9.
29. C. M. Divyashanthi, S. Adithiya kumar, N. Bharathi. Study of prevalence and antimicrobial susceptibility pattern of bacterial isolates in a tertiary care hospital; International Journal of Pharmacy and Pharmaceutical Sciences Vol 7, Issue 1, 2015 :185-190
30. Kaushal V Sheth, Tejas K Patel, Saklainhaider S Malek and CBTripathi. Antibiotic Sensitivity Pattern of Bacterial Isolates from the Intensive Care Unit of a Tertiary Care Hospital in India; Trop J Pharm Res, December 2012;11 (6): 991
31. Ahmadey Z, Mohammed SA. Antimicrobial susceptibility pattern of bacterial isolates in the intensive care unit of Al‑Ansar Hospital, Saudi Arabia. Eur J Adv Res Biol Life Sci 2013;1:17‑27.
32. Sriram S, Vidhya D, Gisha mary George, Manjula Devi AS, Rajalingam BR, Shivashankar V, et al. Study on bacterial spectrum and antibiotic resistance of pathogens at a private corporate hospital. Univeral J Pharm ISSN 2013;2(3):63-8.
33. Vanitha Rani N, Kannan Gopal, Venkata Narendra M, Vishwakanth D, VRD Nagesh, Yogita M, et al. A retrospective study on blood stream infections and antibiotic susceptibility patterns in a tertiary care teaching hospital. Int J Pharm Pharm Sci 2012; 4(1):543-48.
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