Antibiotic Resistance Pattern and Stewardship Programme in Critical Care Settings

Abstract

Sensitivity pattern of isolates from patients’ specimens associated with infection, admitted to the critical care centers with empiric or prophylactic antibiotic use were assessed. Till identification of the organism and resultant sensitivity awaited; and compared with sensitive antibiotic to the isolates which could be used for management. This analytical cross sectional study carried out during the period of April 2016 to July 2016 in the Critical Care Centre (CCC) of Combined Military Hospital, Dhaka Cantonment. Urine and other specimens including wound swab, pus, sputum, tracheal aspirate, catheter tip, nasal swab, high vaginal swab, broncheoalveolar lavage, blood, urethral discharge were collected from the patients following aseptic precautions. Isolate identification was done using standard procedures at the Armed Forces Institute of Pathology (AFIP). Sensitivity was tested using antibiotic disc diffusion technique. A total of one thousand six hundred and seventy patients were dealt with in the study, and positive yield obtained in 190 (11.38%) cases. Of those, 116 were urine specimens which constituted 69 (57.76%) female and 47(42.24%) male patients. A total of 1088 discs of antibiotics were used on an average 9 discs per isolate. Six hundred and forty nine (59.65%) showed resistance to the antibiotic used against them, while four hundred and thirty nine (40.35%) showed sensitive response. The study population was of 2-80 years age group. Other specimens included 74 isolates, fifty (67.57%) were males and twenty four (32.43%) were females. A total of eight hundred and twenty seven (11.18 discs per isolate) antibiotic doses were used 479 (57.92%), showed resistant and 348 (42.08%) sensitive result. Enteric gram negative bacilli (GNB) were the majority of isolates in both types of specimens. The study indicated that, newer antimicrobials have a substantial impact in decreasing human morbidity and mortality rates. It encourages to expand surveillance of antibiotic resistance determinants and to exercise caution in dispensing antibiotics to maximize their continued efficacy. Excess or injudicious use is causing increase in cost as well as inducing drug resistance among the common bacterial isolates. A work on the clinical presentation with trends of antimicrobials used in the CCC setup right now in tertiary care hospital would be of supplemental value for the study.