A Prospective Evaluation of Reserve Antibiotics Utilization Using Daily Defined Dose in HICU of A Tertiary Care Hospital

• Nisha Jose

  Karnataka College of Pharmacy, Rajiv Gandhi university of health sciences, Bengaluru, Karnataka, India.

  Author

• Athira Krishnan

  Karnataka College of Pharmacy, Rajiv Gandhi university of health sciences, Bengaluru, Karnataka, India.

  Author

• Balakeshwa Ramaiah

  Karnataka College of Pharmacy, Rajiv Gandhi university of health sciences, Bengaluru, Karnataka, India.

  Author

• Banjara Raju Prabhudev

  Karnataka College of Pharmacy, Rajiv Gandhi university of health sciences, Bengaluru, Karnataka, India.

  Author

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ABSTRACT

Background: Estimating the antimicrobial consumption is extremely important to monitor the impact of antimicrobial stewardship activities. The primary objective of the study involves analysis of drug use pattern of high-end antibiotics in tertiary care hospital. This study aimed to quantify the use of reserve antibiotics in a High-Intensity Care Unit (HICU) using the WHO-recommended ATC classification and DDD/100 bed-days, assess prescribing trends, and analyze the distribution of pathogens along with antimicrobial resistance patterns, superinfection, and hospital acquired infections mainly- Surgical Site Infection (SSI), central line-associated bloodstream infections (CLABSI)

Methods: A prospective observational study was conducted from January to June 2024 in a tertiary hospital’s HICU, enrolling 85 adult patients who received high-end antibiotics. Exclusions included paediatric, pregnant, and lactating patients. Data on demographics, diagnosis, antibiotic use, culture results, and hospital-acquired infections (HAIs) were collected. Antibiotic utilization was measured in DDD/100 bed-days using the WHO ATC/DDD system, and statistical analysis was performed to assess the association between hospital stay and infection acquisition.

Results:  A total of 85 patients was included, with a mean age of 56.5 ±17 years and a median hospital stay of 15 days. Eleven reserve antibiotics from the WHO Watch list were prescribed, most commonly for sepsis (20.3%), urinary tract infections (19%), septic shock (16.3%), and lower respiratory tract infections (15.7%). Meropenem (28%), colistin (17%), and linezolid (14%) were the most frequently used agents. As per DDD consumption, highest utilization was for tigecycline, with a DDD of 226.5 (13DDD/100 bed days). The least consumed drug was colistin, with a DDD of 13.8 (0.79DDD/100 bed days). The DDD of Restricted Antibiotics prescribed for patients of different wards/departments during the study period was 56.64 DDD.

From 137 isolates, the predominant pathogens were Enterobacter spp. (23%), Klebsiella spp. (18.9%), coagulase-negative staphylococci (13%), Acinetobacter spp. (12.4%), and E. coli (13%), with multidrug resistance most prevalent in Klebsiella spp. CLABSI occurred in 11 patients and SSI in 14 cases.  Superinfections occurred in 24 patients, most often due to Candida, Enterococcus, Acinetobacter, and Klebsiella. Prolonged hospitalization was significantly associated with microorganism acquisition (p = 0.0019).

Conclusion: The study highlights the considerable reliance on reserve antibiotics in the HICU, primarily driven by severe infections, antimicrobial resistance, and extended hospital stays. The detection of 57 MDR isolates emphasizes the growing burden of AMR, while the calculated antibiotic consumption provides a valuable baseline for future comparisons and supports antimicrobial stewardship efforts.

The data supporting the findings of this study are available within the article and its supplementary materials. Additional datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Copyright (c) 2025 Nisha Jose, Athira Krishnan, Balakeshwa Ramaiah, Banjara Raju Prabhudev (Author)

This work is licensed under a Creative Commons Attribution 4.0 International License.