Girish , Harish
BACKGROUND Antimicrobials are one of most commonly used drugs in the admitted patients especially in critical care unit. Seriously ill patients require critical care and multiple antibiotics for various infections as these patients are more susceptible for infections. Liberal use of antibiotics leads to antibiotic resistance and organisms causing infections will not be susceptible to antibiotics. Hence this study is done to evaluate the antimicrobial utilization pattern in a MICU of a tertiary care teaching hospital. MATERIALS AND METHODS A prospective observational study was done on 480 patients getting admitted to MICU of a tertiary-care teaching hospital, Basaweshwara Medical College, Chitradurga. Relevant history, clinical data, investigations including blood routine, urine routine, blood culture and sensitivity, urine culture and sensitivity were noted down and also antimicrobials prescription with respect to type of antibiotic, duration and dose of antibiotics were noted down from the date of admission till the date of discharge from medical ICU. Patients were classified into four categories on the basis of criteria to start antibiotics, that is if antibiotic was started prophylactically or symptoms suggesting infections or evidence of infection present but not bacteriologically proved or bacteriologically proved infection. Data were presented in proportions and expressed in percentages and analysed. RESULTS Out of 480 patients 412 (86%) of patients were prescribed with antibiotics. Majority of patients were prescribed with I V antibiotics. Among 412 patients, symptomatic treatment without any proven infection was seen in 75 (18.2%) patients, prophylactic treatment was seen in 117 (28.39%) patients. 183 (44.4%) patients had increased leukocytes but no evidence of bacterial infection. 37 (8.9%) patients showed culture positive and treated on culture and sensitivity report. Most common infection was pulmonary infections followed by urinary tract infection. Most common drug prescribed was injection ceftriaxone followed by piperacillin + tazobactam. Among 37(8.9%) patients who were positive on culture, 22 (5.3%) had infection with multiple organisms and rest with single organism. Average number of antibiotics used were 6.3. CONCLUSION In our study, only Small portion constituted definitive treatment with antibiotic based on culture sensitive report. In our study, treatment with antimicrobials were rational with respect to dosage, duration, selection of antibiotics and route of administration. Since proven bacterial infection constituted very small proportion, treating with antibiotic demands strict guidelines under vigilance of infectious disease control committee. And also, further studies in which samples sent for culture and sensitivity before starting even single dose of antibiotics may provide clear picture of bacterial infection spectrum and sensitivity to antibiotics there by helping to control drug resistance and making treatment more cost effective.
