Title: Antibiotic Audit in Cases of Septicemia in Medical Intensive Care Unit (MICU) in a Tertiary Care Hospital in Mumbai

Authors: Anuradha S De, Nazneen I Malak, Jayanthi S Shastri

 DOI: https://dx.doi.org/10.18535/jmscr/v7i2.114

Abstract

Introduction: Intensive care units (ICU) are epicenters for the emergence of antibiotic resistance. Overprescribing and misuse of antibiotics are contributing to the development of multidrug resistance (MDR). Hence, this study was carried out to ensure the best clinical outcome for the patient while lowering the risk of antimicrobial resistance.

Aim and Objectives: To identify microorganisms from clinically suspected cases of septicemia in MICU, their antimicrobial susceptibility pattern and to evaluate the rational use of antibiotics.

Materials and Methods: A retrospective study was carried out in a tertiary care hospital for a period of one and a half years. Blood samples were processed in BACTEC 9120 system. Flash positive samples were further processed to identify the organisms by standard techniques and antimicrobial susceptibility test (AST) was performed by Kirby Bauer Disc Diffusion Method on Mueller Hinton Agar.

Results: Total blood cultures received were 309, of which 22.6% showed growth. Commonest species isolated was Acinetobacter spp. (34.3%), followed by Staphylococcus aureus (14.3%) and Escherichia coli (12.9%).MDR and carbapenem resistance were seen in 25% Enterobacteriaceae. MDR in non-fermenters was 50%, whereas carbapenem resistance was 63.3%. Fifty percent Staphylococcus spp were Methicillin resistant and 25% of Enterococci were Vancomycin resistant. On admission, the patients were empirically started on ceftriaxone and amoxicillin-clavulaunic acid. 63% of these patients were later escalated to Carbapenem/Vancomycin, based on the AST reports.

Conclusion: Prospective audit with feedback gives the proper direction to the clinicians and also helps us in formulating antimicrobial policy and revising the policy from time to time.

Keyword: Antibiotic audit, sepsis, antimicrobial resistance, MICU.

References

  1. Moolchandani K, Sastry A S, Deepashree R. Antimicrobial Resistance Surveillance amongIntensive Care Units of a Tertiary Care Hospital in Southern India. J Clin Diagn Res 2017; 11(2): pp 1-7.
  2. Daniel J. Curcio on behalf of the Latin American Antibiotic Use in Intensive Care Unit Group, Antibiotic prescription in intensive care units in Latin America, Revista Argentina de Microbiología 2011; 43: pp 203-211.
  3. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:pp 864–74.
  4. http://www.who.int/news-room/fact-sheets/detail/sepsis.
  5. Dugani S, Veillard J, Reducing the global burden of sepsis, CMAJ 2017 January 9;189:E2-3. doi: 10.1503/cmaj.160798.
  6. PaaryTTS, Kalaiselvan MSRenuka MK, Arunkumar AS, Clinical profile and outcome of patients with severe sepsis treated in an intensive care unit in India. Ceylon Medical J 2016; 6(4): pp181-184. DOI http://doi.org/10.4038/ cmj.v61i4.8386.
  7. Rajeevan S, Syed M A, Jasmin P T, Study of prevalence and antimicrobial susceptibility pattern in blood isolates from a tertiary care hospital in North Kerala, India. Int J Curr Microbiol Appl Sci, 2014, 3(4): pp 655-662.
  8. Luyt C E, Bréchot N,Trouillet J L, Chastre J, Antibiotic stewardship in the intensive care unit.Crit Care 2014; 18:480.
  9. Procop G, Church DL, Hall GS, Janda WM, Koneman EW, Schreckenberger PC, et al. Charts In Koneman’sColour Atlas & Textbook of Diagnostic Microbiology.7th Wolters Kluwer & Lippincott, Williams & Wilkins, Philadelphia 2017; pp 3322-3375.
  10. Performance Standards for Antimicrobial Susceptibility Testing, M100S. Clinical & LaboratoryStandards Institute 2016; M02 A12,M07 A10,M11-A8, pp 56-68.
  11. Ayukekbong J, Ntmegwa M,Atabe A, The threat of antimicrobial resistance in developing countries; causes and control strategies, Antimicrobial Resistance and Infection Control 2017; 6:47.
  12. De Anuradha, Baveja S, D’Souza D and Patwegar S. Antimicrobial resistance among Commonly Encountered Bacteria Isolated in 2013 - the ESKAPE Menace. Intern Med 2015;5:http://dx.doi.org/10.4172/2165-8048.1000193.
  13. Pawar S K, Patil S R, Mohite S T. Antimicrobial Sensitivity pattern of Clinical isolates in Intensive Care Unit in a Tertiary Care Hospital from Western India. Int J Sci Study2016; 4: pp 108-13.
  14. Akrami K, Sweeney DA, Malhotra A, Antibiotic stewardship in the intensive care unit: tools forde-escalation from the American Thoracic Society Meeting 2016; J Thorac Dis2016;8(Suppl7):S533-S535. doi: 10.21037/jtd.2016.07.28.
  15. De A, Baveja S, Renake P, Changing antibiotic susceptibility pattern of Blood Culture Isolates in 2005 and 2010. Int J Med and Appl Sci; 2013 2(3): pp 1-9.
  16. Sachan S, Rawat V, Umesh, Kumar M, Kaur T, Chaturvedi, Susceptibility Pattern of Enterococci at Tertiary Care Hospital. J Glob Infect Dis 2017; 9(2): pp 73–75

Corresponding Author

Anuradha S De

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.