Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India; Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India.
Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India.
J Glob Antimicrob Resist. 2020 Dec;23:315-320. doi: 10.1016/j.jgar.2020.09.028. Epub 2020 Oct 24.
Unregulated and inappropriate use of antimicrobial agents has been a major driver of antimicrobial resistance with a dangerous impact on health issues in developing nations. We report an audit of antimicrobial use patterns in a tertiary-care teaching hospital in order to identify opportunities for antimicrobial stewardship.
A point prevalence survey was conducted to study the use of ten selected antibiotics in various adult inpatient facilities. Patient characteristics as well as indications and patterns of antibiotic prescription were recorded.
A total of 188 patients received any one of the survey antibiotics, accounting for 43% of patients admitted under the study specialties. Of the 188 patients, 59% were admitted in non-intensive care unit settings. The median (interquartile range) duration of hospitalisation during the survey was 8 (4.75) days. Intra-abdominal infections (75; 40%) and respiratory infections (41; 22%) were the most common reasons for admission. Empirical antibiotic use was observed in 66% of patients. Antimicrobial use without any microbiological test was evidenced in 32 patients (17%). Significant differences were noted between medical and surgical specialties in choice of antibiotic, dosage and utilisation of microbiological tests.
High empirical antibiotic use, poor transition from empirical to rational use, and underutilisation of microbiological tests were noted. The choice of antibiotics differed among specialties. Inappropriate dosing was greater in surgical specialties, especially with aminoglycosides. Adherence to local antibiotic policy, optimal dosing and audit of reserved antibiotic use can be useful approaches to strengthen antimicrobial stewardship programmes.
抗菌药物的不受监管和不当使用是导致抗菌药物耐药性的主要因素，对发展中国家的健康问题产生了危险影响。我们报告了对一家三级教学医院抗菌药物使用模式的审核，以确定抗菌药物管理的机会。
进行了一项时点患病率调查，以研究十种选定抗生素在各种成年住院患者中的使用情况。记录了患者特征以及抗生素处方的指征和模式。
共有 188 名患者接受了调查抗生素中的任何一种，占研究专科住院患者的 43%。在 188 名患者中，59% 收治于非重症监护病房。调查期间的中位（四分位间距）住院时间为 8（4.75）天。腹腔内感染（75 例；40%）和呼吸道感染（41 例；22%）是最常见的入院原因。66%的患者接受了经验性抗生素治疗。32 名患者（17%）未进行任何微生物检测就使用了抗菌药物。在抗生素选择、剂量和微生物学检测的使用方面，内科和外科专业之间存在显著差异。
经验性抗生素使用率高、从经验性使用向合理性使用的转变不佳以及微生物学检测的利用率低。抗生素的选择在不同科室之间存在差异。外科专业中，特别是氨基糖苷类药物，存在不适当的剂量。遵循当地的抗生素政策、优化剂量以及对抗菌药物保留使用的审核，可以是加强抗菌药物管理计划的有用方法。
