Audit of Antibiotic Practices: An Experience from a Tertiary Referral Centre

Aims: To estimate the prevalence of antibiotic de-escalation at admission in patients referred to a tertiary hospital in India. The secondary outcomes were the adequacy of empirical antibiotic therapy and culture positivity rates in the de-escalated group. Materials and methods: A prospective observational study, in a 20-bedded ICU of tertiary care hospital. Patients> 18 years, surviving > 48 hours, were included (June-December 2017). Demographic data, previous cultures, and antibiotics from other hospitals, laboratory parameters in the first 24 hours, and severity of illness were noted. Changes made in antibiotic therapy within 48 hours were recorded. Patients were analyzed into three groups: "No change"-empiric therapy was maintained, "Escalation"-switch to or addition of an antibiotic with a broader spectrum, and "De-escalation"-switch to or interruption of a drug class. Results: The total number of patients eligible was 75. The mean age of the population is 43.38 (SD + 3.4) and groups were comparable in terms of mean SOFA and APACHE 2. The prevalence of de-escalation was 60% at admission. The escalation group consisted of 24%. Sixteen percent patients belonged to no change group. Results showed that 38% of patients were on Carbapenems, dual gram negative was given to 26%, and empirical MRSA coverage was 28% on admission. Conclusion: Our study aims to provide data about actual practices in the Indian scenario. It highlights the generous use of high-end antibiotics in the community. Indian practices are far cry from theoretical teaching and western data. The need for antibiotic stewardship program in our country for both public and private health sectors is the need of the hour.