Singh Ritu, Azim Afzal, Gurjar Mohan, Poddar Banani, Baronia Arvind K
Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Indian J Crit Care Med. 2019 Jan;23(1):7-10. doi: 10.5005/jp-journals-10071-23104.
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.
A prospective observational study, in a 20-bedded intensive care unit (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.
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 sequential organ failure assessment score (SOFA) and acute physiology, age, chronic health evaluation (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 methicillin-resistant (MRSA) coverage was 28% on admission.
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.
Singh R, Azim A, Gurjar M, Poddar B, Baronia AK. Audit of Antibiotic Practices: An Experience from a Tertiary Referral Center. Indian Journal of Critical Care Medicine, January 2019;23(1):7-10.
评估转诊至印度一家三级医院的患者入院时抗生素降阶梯治疗的发生率。次要结果是降阶梯治疗组中经验性抗生素治疗的充分性和培养阳性率。
在一家三级护理医院的20张床位的重症监护病房（ICU）进行一项前瞻性观察研究。纳入年龄>18岁、存活时间>48小时的患者（2017年6月至12月）。记录人口统计学数据、既往培养结果、来自其他医院的抗生素使用情况、最初24小时内的实验室参数以及疾病严重程度。记录48小时内抗生素治疗的变化。患者被分为三组：“无变化”——维持经验性治疗；“升级”——换用或加用更广谱的抗生素；“降阶梯”——换用或停用某类药物。
符合条件的患者总数为75例。人群的平均年龄为43.38岁（标准差+3.4），各组在平均序贯器官衰竭评估评分（SOFA）和急性生理与慢性健康状况评分系统（APACHE）Ⅱ方面具有可比性。入院时降阶梯治疗的发生率为60%。升级组占24%。16%的患者属于无变化组。结果显示，38%的患者使用碳青霉烯类抗生素，26%的患者给予双联革兰阴性菌覆盖，入院时经验性耐甲氧西林金黄色葡萄球菌（MRSA）覆盖率为28%。
我们的研究旨在提供有关印度实际情况的数据。它突出了社区中高端抗生素的大量使用。印度的实际做法与理论教学和西方数据相差甚远。我国公共和私营卫生部门对抗生素管理计划的需求迫在眉睫。
辛格R，阿齐姆A，古贾尔M，波达尔B，巴罗尼亚AK。抗生素使用情况审计：来自三级转诊中心的经验。《印度重症医学杂志》，2019年1月；23(1):7 - 10。
