Title : Audit of empirical antimicrobial therapy initiated in ICU & impact of antimicrobial stewardship intervention
Abstract:
Objectives:
To conduct an audit on emperical antimicrobial therapy initiated in ICU and evaluate the impact of Physician led feedback training and education as antimicrobial stewardship programme in India.
Design and setting: Prospective, single-centre cohort study with intervention and feedback training conducted in a 20-bedded ICU of a tertiary care hospital for a period of 10 months , consisting of 3 phases: baseline observation phase of 4 months, education and feedback training for 2 months, and intervention phase for 4 months.
Participants: Patients more than 15 year of age initiated on empirical study antimicrobials in ICU and continued for atleast 48 hours.
Methods:
Medical records and pertinent details of the recruited patients were reviewed by the Physician with infectious disease training. The primary outcome of the study, days of therapy (DOT) of the study antimicrobials per 1000 patient days, along with secondary outcomes such as the appropriateness of antimicrobials used, the length of hospital stay, all-cause mortality, and readmission rates to the Intensive Care Unit (ICU) were calculated. Subsequently, two months of educational training on antimicrobial stewardship and appropriate use were provided to medical professionals involved in managing the study population. During the intervention phase, the Physician with infectious disease training will provide recommendations to ICU team after 48 hours of empirical therapy to change antimicrobials if used inappropriately. The acceptance of these recommendations by the ICU team and the outcomes of the study will be calculated and compared with the observation phase.
Results:
Overall 75 patients were recruited in the baseline observation phase and nearly similar number of patients are being planned to be recruited in the intervention phase. The study antimicrobial use in observation phase was 2374 DOT per 1,000 patient days. Inappropriate antimicrobial use was 58.7 % with inappropriate choice of antimicrobials being the most common reason. The length of ICU and overall hospital stay were 314 and 502 days respectively
Conclusion:
If the results in intervention phase shows reduction in DOT per 1000 patient days and the secondary outcomes, then this physician driven antimicrobial stewardship implementation will be an effective option in reducing inappropriate antimicrobial usage in low resource setting.
