Appropriateness of antimicrobial therapy in medical wards of a tertiary care referral hospital and its effect on antibiotic consumption and in-hospital mortality.

Abstract

Objectives: This study was conducted to find out the appropriateness of antimicrobial therapy in Medical wards of a tertiary care referral hospital in South India. Other objectives were to study the association between appropriateness of antimicrobial therapy and antibiotic consumption and in-hospital patient outcomes.

Methodology: A series of 32 clinical audits were done in the medical wards from January 2018 to June 2019 and a total of 220 patients were included in the study. All patients in whom an antimicrobial agent was initiated were assessed for the appropriateness of their use. Antibiotic consumption was studied using days of therapy. Appropriateness of antibiotic therapy and its impact on patient outcomes were also studied.

Results: Appropriate antimicrobial usage was seen in only 47% patients. Collection of all appropriate cultures before initiation of therapy, timely de-escalation, and intravenous (IV) to per oral step down contributed to lower rates of appropriateness. Patients who received appropriate antimicrobial therapy had significantly lower duration of therapy and nonsignificant lower deaths as compared to those who received inappropriate antimicrobial therapy.

Conclusions: Inappropriate antimicrobial usage is very high in medical wards of a tertiary care referral hospital and lead to higher antibiotic consumption higher in-hospital mortality. The collection of all appropriate cultures before initiation of antimicrobial agents, timely de-escalation, and IV to per oral step down can improve appropriateness.