Culture of cultures: Antimicrobial prescription practices in hospitalised patients at level 1 trauma centre

Introduction: Antibiotic stewardship practices require that antimicrobial treatment should be tailored according to microbiological culture. Therefore, the aim of this study was to describe the antibiotic prescription pattern and to assess how frequently the surgeons request for a specimen culture during the patient's stay. Materials and Methods: This was an observational study; conducted in level-1 trauma center for 10 months and all consecutive neurosurgery patients, admitted in the hospital were included in the study. Detail of microbiology culture and anti-microbial-sensitivity results were recorded. Antibiotic prescriptions were recorded in each patient during their hospital stay. Results: A total of 1216 consecutive patients admitted to the neurosurgery unit were included in the study. The mean age (± standard deviation) of patients was 33.29 (±16.27) years, predominantly male patients; 1038 (85.4%). Overall, culture-confirmed infections were present in 216 (19.4%) patients. Prevalence of Gram-negative bacteria; 195 (90.2%) was more than Gram-positive bacteria; 21 (4.7%) (P < 0.001). The most frequently used antibiotic was cephalosporin; 1030 (84.7%), followed by aminoglycoside; 952 (78.3%), fluoroquinolone; 422 (34.7%), penicillin; 311 (25.6%) and metronidazole 277 (22.8%). A total of 400 (13.15%) antibiotics were prescribed appropriately in patients with culture-confirmed infection while 2640 (86.8%), antibiotics were given inappropriately in rest of the patient in whom there was no matching culture-confirmed infection (P < 0.001). Conclusion: A very small number of antimicrobial prescriptions were based on culture reports. Hospitals in developing countries including India need to institute surgical antibiotic policies soon since most hospitals are facing a severe problem of antimicrobial resistance.