New Antibiotic Prescription Pattern in Critically Ill Patients ("Ant-critic"): Prospective Observational Study from an Indian Intensive Care Unit

Supradip Ghosh; Ripenmeet Salhotra; Amandeep Singh; Aditya Lyall; Garima Arora; Niranjan Kumar; Aayush Chawla; Meenakshi Gupta

doi:10.5005/jp-journals-10071-24366

New Antibiotic Prescription Pattern in Critically Ill Patients ("Ant-critic"): Prospective Observational Study from an Indian Intensive Care Unit

Indian J Crit Care Med. 2022 Dec;26(12):1275-1284. doi: 10.5005/jp-journals-10071-24366.

Authors

Supradip Ghosh¹, Ripenmeet Salhotra², Amandeep Singh¹, Aditya Lyall¹, Garima Arora³, Niranjan Kumar⁴, Aayush Chawla², Meenakshi Gupta¹

Affiliations

¹ Department of Critical Care Medicine, Fortis Escorts Hospital, Faridabad, Haryana, India.
² Department of Critical Care Medicine, Amrita Hospital, Faridabad, Haryana, India.
³ Department of Critical Care Medicine, Werribee Mercy Hospital, Werribee, Victoria, Australia.
⁴ Department of Critical Care Medicine, Mediversal Multi Superspeciality Hospital, Kankarbagh, Patna, Bihar, India.

Abstract

Introduction: This study aimed to address the issue of antibiotic prescription processes in an Indian Intensive care unit (ICUs).

Materials and methods: In a prospective longitudinal study, all adult patients admitted in the ICU for 24 hours or above between 01 June 2020 and 31 July 2021 were screened for any new antibiotic prescription throughout their ICU stay. All new antibiotic prescriptions were assessed for baseline variables at prescription, any modifications during the course, and the outcome of antibiotic prescription.

Results: A total of 1014 patients fulfilled entry criteria; 59.2 and 7.2% of days they were on a therapeutic and prophylactic antibiotic(s). Patients, who were prescribed therapeutic antibiotic(s), had worse ICU outcomes. A total of 49.5% of patients (502 of 1,014) received a total of 552 new antibiotic prescriptions during their ICU stay. About 92.13% of these prescriptions were empirical and blood or other specimens were sent for culture in 78.81 and 60.04% of instances. A total of 31.7% of episodes were microbiologically proven and were more likely to be prescribed by an ICU consultant. A total of 169 modifications were done in 142 prescription episodes; 73 of them after sensitivity results. Thus, the overall rate of de-escalation was 13.95%. Apart from the negative culture result (36.05%), an important reason for a relatively low rate of de-escalation was the absence of sampling (12.32%). Longer ICU stay before antibiotic prescription, underlying chronic liver disease (CLD), worse organ dysfunction, and septic shock were independently associated with unfavorable treatment outcomes. No such independent association was observed between antibiotic appropriateness and patient outcome.

Conclusion: Future antibiotic stewardship strategies should address issues of high empirical prescription and poor microbiological sampling hindering the de-escalation process.

How to cite this article: Ghosh S, Salhotra R, Singh A, Lyall A, Arora G, Kumar N, et al. New Antibiotic Prescription Pattern in Critically Ill Patients ("Ant-critic"): Prospective Observational Study from an Indian Intensive Care Unit. Indian J Crit Care Med 2022;26(12):1275-1284.

Keywords: Antibiotic(s); Intensive care unit; Patient outcome; Prescription process.