Skender Kristina, Machowska Anna, Dhakaita Shyam Kumar, Lundborg Cecilia Stålsby, Sharma Megha
Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, 17177, Stockholm, Sweden.
Department of Surgery, Ruxmaniben Deepchand Gardi Medical College, Surasa, Ujjain, 456006, India.
BMC Public Health. 2024 Jan 27;24(1):310. doi: 10.1186/s12889-024-17817-2.
Inappropriate antibiotic use contributes to the global rise of antibiotic resistance, prominently in low- and middle-income countries, including India. Despite the considerable risk of surgical site infections, there is a lack of antibiotic prescribing guidelines and long-term studies about antibiotic prescribing in surgery departments in India. Therefore, this study aimed to analyse 10 years' antibiotic prescribing trends at surgery departments in two tertiary-care hospitals in Central India.
Data was prospectively collected from 2008 to 2017 for surgery inpatients in the teaching (TH-15,016) and the non-teaching hospital (NTH-14,499). Antibiotics were classified based on the World Health Organization (WHO) Access Watch Reserve system and analysed against the diagnoses and adherence to the National List of Essential Medicines India (NLEMI) and the WHO Model List of Essential Medicines (WHOMLEM). Total antibiotic use was calculated by DDD/1000 patient days. Time trends of antibiotic prescribing were analysed by polynomial and linear regressions.
The most common indications for surgery were inguinal hernia (TH-12%) and calculus of the kidney and ureter (NTH-13%). The most prescribed antibiotics were fluoroquinolones (TH-20%) and 3 generation cephalosporins (NTH-41%), and as antibiotic prophylaxis, norfloxacin (TH-19%) and ceftriaxone (NTH-24%). Access antibiotics were mostly prescribed (57%) in the TH and Watch antibiotics (66%) in the NTH. Culture and susceptibility tests were seldom done (TH-2%; NTH-1%). Adherence to the NLEMI (TH-80%; NTH-69%) was higher than adherence to the WHOMLEM (TH-77%; NTH-66%). Mean DDD/1000 patient days was two times higher in the NTH than in the TH (185 vs 90). Overall antibiotic prescribing significantly increased in the TH (β =13.7) until 2012, and in the NTH (β =0.96) until 2014, and after that decreased (TH, β= -0.01; NTH, β= -0.0005). The proportion of Watch antibiotic use significantly increased in both hospitals (TH, β=0.16; NTH, β=0.96).
Total antibiotic use decreased in the last three (NTH) and five years (TH), whereas consumption of Watch antibiotics increased over 10 years in both hospitals. The choice of perioperative antibiotic prophylaxis was often inappropriate and antibiotic prescribing was mostly empirical. The results of this study confirmed the need for antibiotic prescribing guidelines and implementation of antimicrobial stewardship programs.
抗生素的不当使用导致全球抗生素耐药性上升，在包括印度在内的低收入和中等收入国家尤为突出。尽管手术部位感染风险很大，但印度外科科室缺乏抗生素处方指南以及关于抗生素处方的长期研究。因此，本研究旨在分析印度中部两家三级护理医院外科科室10年的抗生素处方趋势。
前瞻性收集2008年至2017年教学医院（TH - 15,016例）和非教学医院（NTH - 14,499例）手术住院患者的数据。抗生素根据世界卫生组织（WHO）的“准入、观察、储备”系统进行分类，并根据诊断以及对《印度基本药物目录》（NLEMI）和《WHO基本药物示范目录》（WHOMLEM）的依从性进行分析。抗生素总使用量按每1000患者日限定日剂量（DDD）计算。通过多项式和线性回归分析抗生素处方的时间趋势。
最常见的手术指征是腹股沟疝（TH - 12%）和肾及输尿管结石（NTH - 13%）。最常处方的抗生素是氟喹诺酮类（TH - 20%）和第三代头孢菌素（NTH - 41%），作为抗生素预防用药，诺氟沙星（TH - 19%）和头孢曲松（NTH - 24%）。教学医院大多处方“准入”类抗生素（57%），而非教学医院大多处方“观察”类抗生素（66%）。很少进行培养和药敏试验（TH - 2%；NTH - 1%）。对NLEMI的依从性（TH - 80%；NTH - 69%）高于对WHOMLEM的依从性（TH - 77%；NTH - 66%）。非教学医院每1000患者日的平均DDD是教学医院的两倍（185 vs 90）。教学医院的总体抗生素处方量在2012年之前显著增加（β = 13.7），非教学医院在2014年之前显著增加（β = 0.96），之后减少（TH，β = -0.01；NTH，β = -0.0005）。两家医院“观察”类抗生素的使用比例均显著增加（TH，β = 0.16；NTH，β = 0.96）。
在过去三年（NTH）和五年（TH）中，抗生素总使用量下降，而两家医院在10年期间“观察”类抗生素的消耗量增加。围手术期抗生素预防用药的选择通常不合适，抗生素处方大多是经验性的。本研究结果证实了对抗生素处方指南的需求以及抗菌药物管理计划的实施。
