A comparative analysis of retrospective records of antibiotic usage in patients before and after surgery in a tertiary care government hospital in Delhi

Authors

  • Tarun Arora Department of Pharmacology, Lady Hardinge Medical College, New Delhi, India
  • Samya Bhowmick Department of Pharmacology, Lady Hardinge Medical College, New Delhi, India
  • Jasbir Singh Department of Pharmacology, Lady Hardinge Medical College, New Delhi, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20240210

Keywords:

AMR, Retrospective, Antibiotic usage, DDD

Abstract

Background: Antimicrobial resistance (AMR) is major problem in most of countries worldwide. Antimicrobial Stewardship program (AMSP) encourages both government and private hospitals in country to bring out guidelines regarding antimicrobial usage and hospital infection control (HIC). However, it is still in nascent stage.  A retrospective study to generate lacking data about usage of antibiotics in inpatient settings in a government hospital.

Methods: Retrospective records of antibiotic usage in adult patients before and after surgery admitted in department of surgery, LHMC and Smt. Sucheta Kriplani hospital, New Delhi. The prescribed doses were converted to a number as per WHO defined daily dose (DDD) of each antibiotic and presented as per ATC/DDD methodology.

Results: The records of 121 patients admitted between June 2021 to February 2022 were retrieved. Ceftriaxone, was the leading choice of antibiotic both pre and post operatively, while co-amoxyclav was second most preferred antimicrobial. Mean ± SD for DDD pre-op and post-op was 3.345±1.602 with p<0.001 which was highly significant. Mean ± SD for average duration of stay pre-op and post-op was 3.041±1.179 with p<0.01 which was significant. Only 16 patients had complications before, during or after the procedure which prolonged their stay in hospital. There were no procedure related deaths till last follow up. 

Conclusions: Guidelines for selection of proper antimicrobial usage in peri-operative period were not consistent. We advocate evidence-based pre-operative and post-operative antibiotic prophylaxis practices and rational antibiotic usage depending on prevailing antibiogram.

References

Chandy SJ, Michael JS, Veeraraghavan B, Abraham OC, Bachhav SS, Kshirsagar A. ICMR programme on Antibiotic Stewardship, Prevention of Infection and Control (ASPIC). Indian J Med Res. 2014;139(2):226-30.

Kamini W, Ohri VC, Dilip M. Antimicrobial stewardship programme (AMSP) practices in India. Antimicrobial Stewardship Programme of ICMR. 2015;142(2):130-38.

Walia K, Ohri V C, Mathai D, Antimicrobial Stewardship Programme of ICMR. Antimicrobial stewardship programme (AMSP) practices in India. Indian J Med Res. 2015;142:130-8.

Li J, Wang J, Yang Y, Cai P, Cao J, Cai X et al. Etiology and antimicrobial resistance of secondary bacterial infections in patients hospitalized with COVID-19 in Wuhan, China: a retrospective analysis. Antimicrob Resist Infect Control. 2020;9(1):153.

Mahmoudi H. Bacterial co-infections and antibiotic resistance in patients with COVID-19. GMS Hyg Infect Control. 2020;15:Doc35.

Smita AT, Balasheb BG, Bharti RD, Sangeeta SD. Restricted Parenteral Antibiotics Usage Policy in a Tertiary Care Teaching Hospital in India.J Clin Diagn Res. 2017;11(5):FC06-9.

Korableva AA, Yudina EV, Ziganshina LE. J Infect Public Health. Efficacy of Management for Rational Use of Antibiotics in Surgical Departments at a Multi-Disciplinary Hospital: Results of a 7-year Pharmacoepidemiological Research. Vestn Ross Akad Med Nauk. 2017;72(1):26-32.

Garcell HG, Arias AV, Sandoval CP, Valle Gamboa ME, Sado AB, Alfonso Serrano RN. Impact of a focused antimicrobial stewardship program in adherence to antibiotic prophylaxis and antimicrobial consumption in appendectomies. J Infect Public Health. 2017;10(4):415-20.

Borde JP, Kern WV, Hug M, Steib-Bauert M, de With K, Busch HJ, Kaier K. Implementation of an intensified antibiotic stewardship programme targeting third-generation cephalosporin and fluoroquinolone use in an emergency medicine department. Emerg Med J. 2015;32(7):509-15.

WHO. Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment, 2010. Available at: https://www.whocc.no/atc_ddd_index_and_guidelines/guidelines/. Accessed on 03 November 2022.

Garcell HG, Arias AV, Fernandez EA, Guerrero YB, Serrano RN. Antibiotic Consumption During a 4-year Period in a Community Hospital with an Antimicrobial Stewardship Program. Oman Med J. 2016;31(5):352-6.

Dixit A, Kumar N, Kumar S, Trigun V. Antimicrobial resistance: Progress in the decade since emergence of New Delhi metallo-β-lactamase in India. Indian J Comm Med. 2019;44:4.

Van Boeckel TP, Gandra S, Ashok A, Caudron Q, Grenfell BT, Levin SA, Laxminarayan R. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis. 2014;14:742-50.

Bratzler DW. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect. 2013;14:73-156.

Gupta E, Mohanty S, Sood S, Dhawan B, Das BK, Kapil A. Emerging resistance to carbapenems in a tertiary care hospital in north India. Indian J Med Res. 2006;124:95-98.

MacKenzie FM, Gould IM. Quantitative measurement of antibiotic use. Gould IM, van der Meer JWM, eds. Antibiotic Policies: Theory and Practice. Boston, MA: Springer US. 2005;105-18.

Bowater RJ, Stirling SA, Lilford RJ. Is antibiotic prophylaxis in surgery a generally effective intervention? testing a generic hypothesis over a set of meta-analyses. Ann Surg. 2009;249:551.

Allegranzi B, Bassim Z, Peter B, Zeynep NK, Stijn de J, Fleur de V et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016;16(12):e288-303.

Berr´ıos-Torres SI, craig AU, Dale WB, Brian L, Erin CS, Rachel RK et al. Centers for disease control and prevention guideline for the prevention of surgical site infection. JAMA Surg. 2017;152(8):784-91.

Downloads

Published

2024-01-30

How to Cite

Arora, T., Bhowmick, S., & Singh, J. (2024). A comparative analysis of retrospective records of antibiotic usage in patients before and after surgery in a tertiary care government hospital in Delhi. International Journal of Research in Medical Sciences, 12(2), 455–460. https://doi.org/10.18203/2320-6012.ijrms20240210

Issue

Section

Original Research Articles