Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.
Department of Paediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.
PLoS One. 2024 Sep 19;19(9):e0310515. doi: 10.1371/journal.pone.0310515. eCollection 2024.
Antimicrobials are frequently used in critically ill children admitted to the Paediatric Intensive Care Unit (PICU). The antimicrobial use data from Indian PICUs is limited using standard metrics such as Days of therapy (DOT). This study aimed to determine the baseline trend of antimicrobial use in PICU of a tertiary care teaching hospital of Raipur district of Chhattisgarh, India using standard metrics with the goal of developing facility-wide antibiotic policy and strengthening the antimicrobial stewardship activities. This active surveillance was conducted over a period of 18 months, from November 1, 2019, to March 21, 2021, in patients aged one month to 14 years who were admitted for ≥ 48 hours to the PICU at a tertiary care teaching hospital of Raipur District. Data on patient characteristics, antimicrobial indications, antimicrobial prescription information, and clinical outcomes were collected using pre-designed data abstraction forms. The descriptive statistic was used to represent the results. The antimicrobial consumption was analyzed according to the WHO AWaRe Class (Access, Watch, and Reserve groups) of antibiotics. The antimicrobial consumption was expressed as DOT/1000 patient-days (PD). A total of 216 patients were surveyed during the study period. The average number of antimicrobials prescribed per hospitalisation was 2.60 (range: 1-12), with 97.22% administered via parenteral route. Overall, DOT/1000-PD was 1318. The consumption of Watch Group antimicrobials was highest with 949 DOT/1000-PD, followed by Access (215) and Reserve Group (154), respectively. Ceftriaxone (208 DOT/1000 PD) was the most commonly prescribed antimicrobial agent, followed by Vancomycin (201), Meropenem (175), Piperacillin-Tazobactam (122) and Colistin (91). The patients who were escalated (28.24%) from empirical antimicrobial therapy had longer median PICU stay (8 days) compared those who were de-escalated (23.6%). Targeted therapy was given in 10.2% patients. The overall mortality rate was 14.35% and was higher (29.3%) in patients in whom empirical therapy was escalated compared to those who were de-escalated or continued. The study established a benchmark for antimicrobials use in the PICU and highlighted priority areas for antimicrobial stewardship intervention to enhance de-escalation rates, enhance targeted therapy, and reduce the overuse of antimicrobials especially belonging to the reserve group.
在入住儿科重症监护病房（PICU）的危重症儿童中，经常使用抗生素。使用标准指标（如治疗天数（DOT）），印度 PICU 的抗生素使用数据有限。本研究旨在使用标准指标确定印度恰蒂斯加尔邦赖布尔区三级教学医院 PICU 的抗生素使用基线趋势，目的是制定全院抗生素政策和加强抗生素管理活动。这项主动监测在 18 个月的时间内进行，从 2019 年 11 月 1 日至 2021 年 3 月 21 日，在三级教学医院 PICU 住院时间≥48 小时的 1 个月至 14 岁的患者中进行。使用预先设计的数据提取表收集患者特征、抗生素适应症、抗生素处方信息和临床结果数据。使用描述性统计来表示结果。根据世界卫生组织 AWaRe 类（准入、观察和储备组）对抗生素进行抗生素消耗分析。抗生素消耗以每 1000 名患者-天（PD）的治疗天数（DOT）表示。在研究期间共调查了 216 名患者。每次住院的抗生素处方数平均为 2.60（范围：1-12），97.22%通过肠外途径给药。总体而言，DOT/1000-PD 为 1318。观察类抗生素的消耗最高，为 949 DOT/1000-PD，其次是准入类（215）和储备类（154）。头孢曲松（208DOT/1000PD）是最常用的抗生素，其次是万古霉素（201）、美罗培南（175）、哌拉西林-他唑巴坦（122）和黏菌素（91）。从经验性抗生素治疗升级（28.24%）的患者的 ICU 中位住院时间（8 天）长于降级（23.6%）的患者。10.2%的患者接受了靶向治疗。总死亡率为 14.35%，经验性治疗升级的患者（29.3%）高于降级或继续治疗的患者。该研究为 PICU 抗生素使用建立了基准，并确定了抗生素管理干预的优先领域，以提高降级率、增强靶向治疗并减少抗生素的过度使用，特别是储备类抗生素。
