A Drug Utilization Study of Antimicrobials in Major Surgical Patients in Tertiary Care Teaching Hospital- A Prospective Observational Study

Title: A Drug Utilization Study of Antimicrobials in Major Surgical Patients in Tertiary Care Teaching Hospital- A Prospective Observational Study

Authors: Dr Vidisha Vivek Parulekar, Dr Vandana Avinash Badar, Dr Vartika Gupta, Dr Priti Garate

DOI: https://dx.doi.org/10.18535/jmscr/v8i4.44

Abstract

Introduction: Surgical site infection (SSI) is the most common post-operative complication and represents a significant burden in terms of patient morbidity and mortality, and cost to health services around the world. Appropriate antibiotic prophylaxis has been shown to be effective in reducing the incidence of surgical site infections as studies suggest that 40-60% of these infections are preventable.

Aims: To evaluate and compare the utilization pattern of antimicrobial agents (AMA) in surgical prophylaxis use in preoperative, intraoperative and post-operative wards of different specialities.

Settings and Design: It is a cross-sectional observational study conducted patients admitted to surgery, orthopaedics, ENT and gynaecology wards in tertiary teaching care hospital.

Methods and Material: The study duration was from November 2016-November 2018 (2 years).The data was collected time to time from all the medical records of the patient. The study protocol was approved by the Institutional Ethics Committee.

Statistical Analysis Used: Data was collected and compiled using Microsoft Excel 2010 and then analysed by calculating simple proportions, frequency and percentage of various parameters.

Results: Out of 386 patients, it was observed that female patients (55.69%) were more than male (44.60%) patients. The majority of surgical wounds were clean (39.11%) and most common antimicrobial used pre-operatively was metronidazole (29.24%) and in the intraoperative and postoperative period was gentamicin (54.28%). Number of DDD for inj.amoxicillin-clavulanic acid 1.2g was 274.4.

Conclusions: After observing the trend of use of antibiotics, there is a clear need for the development of prescribing guidelines and educational initiatives to encourage the appropriate use of antimicrobials in surgical period. Also, there is scope for improving prescribing habits among the fraternity and minimizing incidence of resistance to antimicrobials.

Keywords: surgical site infection, pre-operative, intra-operative, post-operative, antibiotic prophylaxis.

References

Stone PW. Economic burden of healthcare-associated infections: an American perspective. Expert review of pharmacoeconomics & outcomes research. 2009 Oct 1;9(5):417-22.

Meeks DW, Lally KP, Carrick MM, Lew DF, Thomas EJ, Doyle PD, Kao LS. Compliance with guidelines to prevent surgical site infections: as simple as 1-2-3?. The American Journal of Surgery. 2011 Jan 1;201(1):76-83.

CDC. Data from National Hospital Discharge Survey. 2010. Available at : https://www.cdc.gov/nchs/data/nhds/4procedures/2010pro_numberpercentage.pdf. Accessed September 2018.

Mu Y, Edwards JR, Horan TC, Berrios-Torres SI, Fridkin SK. Improving risk-adjusted measures of surgical site infection for the National Healthcare Safely Network. Infection Control & Hospital Epidemiology. 2011 Oct;32(10):970-86.

Klevens RM, Edwards JR, Richards Jr CL, Horan TC, Gaynes RP, Pollock DA, Cardo DM. Estimating health care-associated infections and deaths in US hospitals, 2002. Public health reports. 2007 Mar;122(2):160-6.

National Treatment Guidelines for Antimicrobial Use in Infectious Diseases (2016) http://pbhealth.gov.in/AMR_guideline7001495889.pdf

Treatment Guidelines for Antimicrobial Use in Common Syndromes [Internet]. New Delhi; 2017 [cited 28 November 2018]. Available from: https://www.icmr.nic.in/sites/default/files/guidelines/treatment_guidelines_for_antimicrobial.pdf

Bratzler DW, Hunt DR. The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clinical infectious diseases. 2006 Aug 1;43(3):322-30.

Hawn MT, Vick CC, Richman J, Holman W, Deierhoi RJ, Graham LA, Henderson WG, Itani KM. Surgical site infection prevention: time to move beyond the surgical care improvement program. Annals of surgery. 2011 Sep 1;254(3):494-501.

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infection Control & Hospital Epidemiology. 1999 Apr;20(4):247-80.

WHO. How to investigate drug use in health facilities: selected drug indicators, action program on essential drugs (DAP), Geneva, 1993. Available at: http://apps.who.int/medicinedocs/en/d/Js2289e/. Accessed on 19 September 2018.

WHOCC - Purpose of the ATC/DDD system [Internet]. Available from: https://www.whocc.no/atc_ddd_methodology/purpose_of_the_atc_ddd_system/

Akter SF, Rani MF, Rahman JA, Nordin MS, Satwi S, Awang MB. Antimicrobial use and factors influencing prescribing in medical wards of a tertiary care hospital in Malaysia. Int J Sci Environ Technol. 2012;1(4):274-84.

Sharma P, Goel D. Utilization assessment of antimicrobial prophylaxis in surgical patients at tertiary care teaching hospital. Saudi Journal for Health Sciences. 2018 Jan 1;7(1):23.

Bhataia S, Mathur S, Sankhla S, Kumar M, Sharma M. International Journal of Pharma and Bio Sciences ISSN 2016 April; 7(2):332 – 338.

Khan MLZ, Arain A, Qureshi FA. Patient’s selection in limited resources a stimulus for improving care. PJS2008, 24, (4), 35-8.

Alemkere G. Antibiotic usage in surgical prophylaxis: A prospective observational study in the surgical ward of Nekemte referral hospital. PloS one. 2018 Sep 13;13(9):e0203523.

Kamath SG, Varun HV, Rani DU, Aithal S and Patil UN: Prescribing patterns of antimicrobials in surgical departments in a Tertiary Care Hospital in South India. Int J Pharm Sci Res 2014; 5(3): 1051-58

Rehan HS, Kakkar AK, Goel S. Pattern of surgical antibiotic prophylaxis in a tertiary care teaching hospital in India. International journal of infection control. 2010;6(2).

Sozen H, Cetinkaya M, Sahan MU, Caylak SD, Hazer DB, Canbek UM, Koca YS, Baldemir E. Cost and efficacy of perioperative antibiotic prophylaxis in a state hospital in Turkey. Acta Medica. 2013 Jan 1;29:455-60.

Patel DJ, Chhaiya SB, Mehta DS. Drug utilization study-pattern of use of anti-microbial drugs among post-operative patients in department of general surgery at a tertiary care hospital. Int J Basic Clin Pharmacol 2017;6:1482-5.

Goodman L, Gilman A, Brunton L, Hilal-Dandan R, Knollmann B, Buxton I. Principles of Prescription Order Writing and Patient Compliance : Goodman & Gilman's the pharmacological basis of therapeutics. 13th ed. New York [i 11 pozostałych]: McGraw-Hill Education; 2018.

Bhansali NB, Gosai TR, Dholaria NK, Suthar SD, Chacko J,Chavda DA, et al. Drug utilization study in post-operative patients in surgical ward of a tertiary hospital attached with medical college. Der Pharm Lett. 2013; 5(1):251-7.

Kumar R, Kohli Kamlesh, Sidhu D. S., Kaur Navjot, Mala Chandra, Garg Monique. An indepth study of drugs prescribing pattern in the Surgery Department of a Tertiary Care Teaching Institute in Northern India. Int J Basic ClinPharmacol. 2014 Aug; 3(4):681-686.

Bhabhor P, Hotchandani H. An Antibacterial Drug Utilization Study at Surgical Units of Shree Sayaji General Hospital, Vadodara, Gujarat, India. The Internet J Pharmacol. 2012;10(1):1-11.

Agrawal JM, Patel NM, Vaniya HV, Trivedi HR, Balat JD. Drug utilization study in post-operative patients in obstetrics and gynaecology ward of a tertiary care teaching hospital. J Clin Exp Res. 2014;2:103-109.

Tourmousoglou CE, Yiannakopoulou EC, Kalapothaki V, Bramis J, St. Papadopoulos J. Adherence to guidelines for antibiotic prophylaxis in general surgery: A critical appraisal. J Antimicrob Chemother 2008;61:214‑8.

Khan AK, Mirshad PV, Rashed MR, Banu G. A study on the usage pattern of antimicrobial agents for the prevention of surgical site infections (SSIs) in a tertiary care teaching hospital. J Clin Diagn Res 2013;7:671‑4.

Scotish Intercollegiate Guidelines Network. Updated April 2014 Antibiotic Prophylaxis in Surgery – A National Clinical Guideline; 2008. Available from: http://www.sign.ac.uk/pdf/sign104. [Last accessed on 2018 Nov 5].

World Health Organization. Guidelines for Safe Surgery: Safe Surgery Saves Lives. Geneva: World Health Organization; 2009. Available from: http://www.who.int/patientsafety/safesurgery/tools_ resources/9789241598552/en/. [Last accessed on 2018 Nov 5].

Chandrasekaran K, Saeed K, Gandhiraj D, Mohanta GP, Rajasekaran A. Study on Adherence to Prophylactic Antimicrobials Use Guidelines in Surgical Wards of an Indian Private Corporate Hospital. International Journal of Pharmaceutical Research and Allied Sciences. 2016 Jan 1;5(2):280-92.

Divyashree L, Bhushan A and Tejaswini K. Drug utilisation study in gynaecological post-operative cases: a retrospective study. EJPMR.2017;4(04):418-423.

Rode S and Salankar H: Analysis of antimicrobial usage pattern: a retrospective observational study. Int J Pharm Sci & Res 2018; 9(3): 1231-36. doi: 10.13040/IJPSR.0975-8232.9(3).1231-36.

Ali H, Zafar F, Alam S, Beg AE, Bushra R, Manzoor A, Naqvi GR, Yasmeen R, Shafiq Y, Tariq A, Zubair S. Drug utilization and prescribing pattern of antibiotics in a tertiary care setups; trends and practices. Pakistan journal of pharmaceutical sciences. 2018 Mar 2;31.

R. Revathi, N. Saralaand A. Bhaskaran. Prescribing Pattern of Antimicrobials in Patients during Post-Operative Period – An Observational Study. British Journal of Medicine & Medical Research. 2015;5(10):1213-1219

Abstract

References

Corresponding Author

Call For Paper Volume 12 Issue 10 November 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles

Search

Abstract

Call For Paper Volume 12 Issue 10 November 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles