Antibiotic Stewardship Practices and Prescribing Patterns Across Indian PICUs.

Abstract

OBJECTIVES:

To elicit antibiotic prescribing patterns across Indian Pediatric Intensive Care Units (PICU) and assess attributes of the antibiotic stewardship programs.

METHODS:

A link to a web-based questionnaire was sent by email to pediatric intensivists across India.

RESULTS:

Responses were received from 62 PICUs. Majority of respondents were from private hospitals [49/62 (79.5%)]. The most commonly reported infection requiring PICU admission was community-acquired pneumonia [by 39 (62.9%) PICUs] followed by gastroenteritis [26 (41.9%)], and meningitis [15 (24.1%)]. The blood culture positivity rates varied among participating PICUs with 37 centers (59.6%) reporting low blood culture positivity yield (< 40%). Majority of the respondents acknowledged using a 7-d course of antibiotics even in culture-negative sepsis. Most common empiric antibiotics prescribed for community-acquired infections were beta-lactam monotherapy. The typical beta-lactam prescribed was ceftriaxone. However, for hospital-acquired infections (HAI), such as suspected catheter-related bloodstream infection (CLABSI) and suspected ventilator-associated pneumonia (VAP), a higher number of respondents-39/62 (61.9%) and 33/62 (53.2%), respectively, prescribed combination antibiotics (β-lactam + vancomycin). Forty-two units (67.7%) reported having an antibiotic stewardship program in their PICUs, while twenty-nine (45.1%) centers stated having formulary restrictions. Ten (16.1%) centers had pre-authorization policy for certain antibiotics.

CONCLUSION:

A rather diverse pattern of prescribing and administration practices exists across different Indian PICUs. While antibiotic stewardship programmes are established in most centers, formulary restriction and pre-authorisation of antibiotic prescribing were reported by few units. Regular surveillance studies are needed to bring uniformity in antibiotic policy and select appropriate empiric therapy.

• Authors: Arpita Chattopadhyay, Aparna Mukherjee, S K Kabra, Rakesh Lodha
• Journal: Indian journal of pediatrics (Indian J Pediatr) Vol. 89 Issue 9 Pg. 872-878 (09 2022) ISSN: 0973-7693 [Electronic] India
• PMID: 34855068 (Publication Type: Journal Article)
• Copyright: © 2021. Dr. K C Chaudhuri Foundation.

Chemical References

• Anti-Bacterial Agents
• beta-Lactams

Topics

• Anti-Bacterial Agents (therapeutic use)
• Antimicrobial Stewardship
• Child
• Humans
• Intensive Care Units, Pediatric
• Pneumonia, Ventilator-Associated
• beta-Lactams