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

Abstract

A bstract 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.

Modification of Initial Empirical Antibiotic Prescription and its Impact on Patient Outcome: Experience of an Indian Intensive Care Unit

“…Empiric prescription of broad-spectrum antibiotics is common in intensive care units (ICUs), aiming to improve the appropriateness of initial antibiotic regimen, which in-turn is associated with better outcome in infected critically ill patients. 1 However, this strategy comes at the cost of often unnecessary prescription, adverse effects of specific antibiotic, and ultimate societal cost of increasing antimicrobial resistance (AMR). 2 Duration of antibiotic exposure is directly correlated with subsequent development of AMR.…”

“… 8 , 9 Moreover, de-escalation strategy may not be feasible in many ICU patients either because patients are not clinically stable or de-escalation is not feasible because of the resistance pattern or nonavailability of positive culture result. 1 , 10 Several studies have compared culture-negative sepsis with culture-positive ones. 11 – 13 In one study, culture-negative sepsis had worse outcome, whereas, in others, outcomes were better.…”

“…Importantly, clinical course of all patients with culture-negative sepsis may not be the same; initial antibiotic prescriptions are still modified in many of them, while others continue with the initial regimen. 1 …”

“…Given the limited available data on the overall impact of antibiotic modification pattern both in culture-positive and culture-negative sepsis, on the outcome of critically ill patients, especially in Indian scenario, we conducted a retrospective review of “ANTibiotic Prescription Pattern in CRITICally Ill Patients (ANT-CRITIC)” study database published in this journal. 1 “ANT-CRITIC” was a prospective longitudinal study, conducted between 01 June 2020 and 31 July 2021 in the 18-bedded ICU of Fortis-Escorts Hospital, Faridabad, Haryana. “ANT-CRITIC” study looked into all aspects of antibiotic prescription process in an Indian ICU.…”