Antibacterial utilization study in patients admitted to medical intensive care unit of major hospital of india
- Conditions
- Patients admitted to Medicine Intensive Care Unit
- Registration Number
- CTRI/2014/12/005297
- Lead Sponsor
- Seth GS Medical College and KEM Hospital
- Brief Summary
**Demographics:**
A total of 700 participants were recruited across the five centers (140per centers). The median age across centers was 48 (13, 92). There were 424(60.57%) male and 276 (39.43%) female.**Indicators:**
In public (KEM andNair) and government-Tata (autonomous)hospitals, the average number of drugs were significantly higher compared to private(Bombay and Subharti ) hospitals; however, average number of antibacterials ingovernment hospital were significantly higher compared to public and privatehospitals. The average number of antibacterials prescribed in KEMHospital (2.93 ± 2.12) were significantly higher than the Nair Hospital (1.28±0.53); although both the hospitals are public hospitals. Percentage of antibacterials prescribed at publichospitals were not significantly higher than the government hospital andprivate hospitals (p=0.2009); however, the percentage of antibacterialsprescribed at Nair hospital were significantly lower than the other centers(p<0.0001). Percentage of patientsreceived antibacterials were significantly different between public, governmentand private hospitals (p=0.0014) and between the individual centers (p=0.0003). Private hospitals had lower percentage ofantibacterial agents prescribed by generic name (P< 0.0001). There was no significant difference inintravenous use (p=0.2586) ofantibacterials and the fixed dose combinations (p=0.91). At government and private hospitals, none ofthe patient received antibacterial from hospital pharmacy.
Nair Hospital had significantly lower percentage ofpatients in whom antibacterial agent was changes over the course of MICUadmission as well as had very low percentage of antibacterial treatment as persensitivity pattern (p<0.0001). Subharti Hospital had leastpercentage of patients who received antibacterial treatment as per sensitivitypattern and is statistically significant (< 0.0001). KEM Hospital had longer average length ofantibacterial treatment and longer length of empirical use of antibacterials aswell as longer length of MICU stay compared to all other centers. BombayHospital and Tata hospital had highest per patient cost of antibacterialtreatment. Public hospital had significantly lower per patient cost ofantibacterial treatment (<0.0001). Significantly higher mortality was observed inpublic and government hospitals compared to private hospitals (< 0.0001). Penicillins, glycopeptides,Beta-Lactams and Polymyxin-E were comparatively largely prescribed at KEM andTata hospitals. Cephalosporin’s use was high at public hospitals. At Bombayhospital flouroquinolones was largely prescribed. Prescription of Vancomycin and Colistin was foundto be higher at KEM and Tata hospital.
**Pooled data:**
Patients in MICUreceived as many as 10.90 (± 6.83) drugs, of which only 1.98 ± 1.36 (16.11 %)were the antibacterials. Over the study period, 92.42 % patients receivedantibacterials of which 41.00% antibacterials were prescribed by generic name.A total of 93.89 % antibacterials prescribed intravenously. Only 28%antibacterials were prescribed from hospital pharmacy. Change of antibacterialagent was required in 31.75 % patients and only 3.54 % were prescribed as FDCs.The average length of MICU stay was 6.33 (±7.31), average length ofantibacterial treatment was 6.38 (±7.54) and average duration of empiricaltreatment was 5.94 (±5.35). Across the centers average antibacterial cost perpatient was 7781.58 (± 4636.054). A total of 88 culture tests were positive amongst212 patients, from which 71 (80.68%) patients received antibacterials as persensitivity pattern.
A total of 293.41 DDDs/100 bed days’ antibacterials consumed overthe study period. Large amount ofantibacterials consumed at KEM (91.93 DDDs/100 bed days), Tata (94.60 DDDs/100bed days) and Bombay (75.87 DDDs/100 bed days) hospitals compared to Nair(16.90 DDDs/100 bed days) and Subharti (14.11 DDDs/100 bed days) hospitals.Penicillins (KEM-18.79 DDDs/100 bed days, Bombay-23.48 DDDs/100 bed days) andcephalosporins (KEM=23.67 DDDs/100 bed days, Bombay=22.28 DDDs/100 bed days)were largely consumed at KEM and Bombay, while the glycopeptides (Tata-8.73DDDs/100 bed days and KEM-7.08 DDDs/100 bed days) and B-lactams (Tata-32.6DDDs/100 bed days and KEM-14.14 DDDs/100 bed days) were highly consumed at Tata and KEM Hospital.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Completed
- Sex
- All
- Target Recruitment
- 700
Patients either gender of above 14 years old admitted to Medicine Intensive Care Unit.
Not willing to participate in the study.
Study & Design
- Study Type
- Observational
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method 1. Proportion of patients receiving either vancomycin or colistin or both All the outcomes will be assessed at the end of the study 2.Prescribed daily dose (PDD) of antibacterial agents All the outcomes will be assessed at the end of the study 3.Defined daily doses (DDDs) per 100 bed-days for individual antibacterial agents All the outcomes will be assessed at the end of the study
- Secondary Outcome Measures
Name Time Method 1.Proportion of antibacterial agents prescribed over the study period 2.To assess the proportion of antibacterials prescribed on the basis of culture and sensitivity report
Trial Locations
- Locations (5)
Bombay Hospital and Medical Research Centre
🇮🇳Mumbai, MAHARASHTRA, India
Seth GS Medical College and KEM Hospital
🇮🇳Mumbai, MAHARASHTRA, India
Subharti Medical College and Hospital
🇮🇳Meerut, UTTAR PRADESH, India
T N Medical college and BYL Nair Charitable Hospital Mumbai Central Mumbai
🇮🇳Mumbai, MAHARASHTRA, India
Tata Memorial Hospital
🇮🇳Mumbai, MAHARASHTRA, India
Bombay Hospital and Medical Research Centre🇮🇳Mumbai, MAHARASHTRA, IndiaDr Sanjay WaglePrincipal investigator02222091325scwagle@gmail.com