"Antimicrobial utilization in a paediatric intensive care unit in India: A step towards strengthening antimicrobial stewardship practices"
Antimicrobials are frequently used in critically ill children admitted to the Paediatric Intensive Care Unit (PICU). The antimicrobial use data from Indian PICUs is limited using standard metrics such as Days of therapy (DOT). This study aimed to determine the baseline trend of antimicrobial use in...
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| Veröffentlicht in: | PloS one 2024-09, Vol.19 (9), p.e0310515 |
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| creator | Singh, Madhusudan Prasad Gaikwad, Nitin Rewaram Keche, Yogendra Narayanrao Jindal, Atul Dhaneria, Suryaprakash Gurunthalingam, Meenalotchini Prakash |
| description | Antimicrobials are frequently used in critically ill children admitted to the Paediatric Intensive Care Unit (PICU). The antimicrobial use data from Indian PICUs is limited using standard metrics such as Days of therapy (DOT). This study aimed to determine the baseline trend of antimicrobial use in PICU of a tertiary care teaching hospital of Raipur district of Chhattisgarh, India using standard metrics with the goal of developing facility-wide antibiotic policy and strengthening the antimicrobial stewardship activities. This active surveillance was conducted over a period of 18 months, from November 1, 2019, to March 21, 2021, in patients aged one month to 14 years who were admitted for ≥ 48 hours to the PICU at a tertiary care teaching hospital of Raipur District. Data on patient characteristics, antimicrobial indications, antimicrobial prescription information, and clinical outcomes were collected using pre-designed data abstraction forms. The descriptive statistic was used to represent the results. The antimicrobial consumption was analyzed according to the WHO AWaRe Class (Access, Watch, and Reserve groups) of antibiotics. The antimicrobial consumption was expressed as DOT/1000 patient-days (PD). A total of 216 patients were surveyed during the study period. The average number of antimicrobials prescribed per hospitalisation was 2.60 (range: 1-12), with 97.22% administered via parenteral route. Overall, DOT/1000-PD was 1318. The consumption of Watch Group antimicrobials was highest with 949 DOT/1000-PD, followed by Access (215) and Reserve Group (154), respectively. Ceftriaxone (208 DOT/1000 PD) was the most commonly prescribed antimicrobial agent, followed by Vancomycin (201), Meropenem (175), Piperacillin-Tazobactam (122) and Colistin (91). The patients who were escalated (28.24%) from empirical antimicrobial therapy had longer median PICU stay (8 days) compared those who were de-escalated (23.6%). Targeted therapy was given in 10.2% patients. The overall mortality rate was 14.35% and was higher (29.3%) in patients in whom empirical therapy was escalated compared to those who were de-escalated or continued. The study established a benchmark for antimicrobials use in the PICU and highlighted priority areas for antimicrobial stewardship intervention to enhance de-escalation rates, enhance targeted therapy, and reduce the overuse of antimicrobials especially belonging to the reserve group. |
| doi_str_mv | 10.1371/journal.pone.0310515 |
| format | Article |
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The antimicrobial use data from Indian PICUs is limited using standard metrics such as Days of therapy (DOT). This study aimed to determine the baseline trend of antimicrobial use in PICU of a tertiary care teaching hospital of Raipur district of Chhattisgarh, India using standard metrics with the goal of developing facility-wide antibiotic policy and strengthening the antimicrobial stewardship activities. This active surveillance was conducted over a period of 18 months, from November 1, 2019, to March 21, 2021, in patients aged one month to 14 years who were admitted for ≥ 48 hours to the PICU at a tertiary care teaching hospital of Raipur District. Data on patient characteristics, antimicrobial indications, antimicrobial prescription information, and clinical outcomes were collected using pre-designed data abstraction forms. The descriptive statistic was used to represent the results. The antimicrobial consumption was analyzed according to the WHO AWaRe Class (Access, Watch, and Reserve groups) of antibiotics. The antimicrobial consumption was expressed as DOT/1000 patient-days (PD). A total of 216 patients were surveyed during the study period. The average number of antimicrobials prescribed per hospitalisation was 2.60 (range: 1-12), with 97.22% administered via parenteral route. Overall, DOT/1000-PD was 1318. The consumption of Watch Group antimicrobials was highest with 949 DOT/1000-PD, followed by Access (215) and Reserve Group (154), respectively. Ceftriaxone (208 DOT/1000 PD) was the most commonly prescribed antimicrobial agent, followed by Vancomycin (201), Meropenem (175), Piperacillin-Tazobactam (122) and Colistin (91). The patients who were escalated (28.24%) from empirical antimicrobial therapy had longer median PICU stay (8 days) compared those who were de-escalated (23.6%). Targeted therapy was given in 10.2% patients. The overall mortality rate was 14.35% and was higher (29.3%) in patients in whom empirical therapy was escalated compared to those who were de-escalated or continued. The study established a benchmark for antimicrobials use in the PICU and highlighted priority areas for antimicrobial stewardship intervention to enhance de-escalation rates, enhance targeted therapy, and reduce the overuse of antimicrobials especially belonging to the reserve group.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0310515</identifier><identifier>PMID: 39298455</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Anti-Bacterial Agents - therapeutic use ; Anti-infective agents ; Anti-Infective Agents - therapeutic use ; Antibiotics ; Antimicrobial agents ; Antimicrobial Stewardship ; Biology and Life Sciences ; Ceftriaxone ; Child ; Child, Preschool ; Clinical outcomes ; Cloxacillin ; Colistin ; Consumption ; Data collection ; Dosage and administration ; Drug resistance ; Drug resistance in microorganisms ; Female ; Health aspects ; Hospitals ; Humans ; India ; Infant ; Intensive care ; Intensive Care Units, Pediatric ; Length of stay ; Male ; Medical care ; Medical research ; Medicine and Health Sciences ; Medicine, Experimental ; Meropenem ; Mortality ; Nosocomial infections ; Patients ; Pediatric intensive care ; Pediatrics ; Piperacillin-tazobactam ; Prevention ; Quality management ; Strengthening ; Tazobactam ; Tertiary Care Centers ; Therapy ; Vancomycin</subject><ispartof>PloS one, 2024-09, Vol.19 (9), p.e0310515</ispartof><rights>Copyright: © 2024 Singh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2024 Public Library of Science</rights><rights>2024 Singh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2024 Singh et al 2024 Singh et al</rights><rights>2024 Singh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c506t-dbfed232fab6a259c1cfab99c73a2844c740c9297fe23f04305166e8878b94923</cites><orcidid>0000-0003-0064-0019 ; 0000-0003-0295-3262</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412675/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412675/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39298455$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Czarniak, Petra</contributor><creatorcontrib>Singh, Madhusudan Prasad</creatorcontrib><creatorcontrib>Gaikwad, Nitin Rewaram</creatorcontrib><creatorcontrib>Keche, Yogendra Narayanrao</creatorcontrib><creatorcontrib>Jindal, Atul</creatorcontrib><creatorcontrib>Dhaneria, Suryaprakash</creatorcontrib><creatorcontrib>Gurunthalingam, Meenalotchini Prakash</creatorcontrib><title>"Antimicrobial utilization in a paediatric intensive care unit in India: A step towards strengthening antimicrobial stewardship practices"</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Antimicrobials are frequently used in critically ill children admitted to the Paediatric Intensive Care Unit (PICU). 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The overall mortality rate was 14.35% and was higher (29.3%) in patients in whom empirical therapy was escalated compared to those who were de-escalated or continued. The study established a benchmark for antimicrobials use in the PICU and highlighted priority areas for antimicrobial stewardship intervention to enhance de-escalation rates, enhance targeted therapy, and reduce the overuse of antimicrobials especially belonging to the reserve group.</description><subject>Adolescent</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Anti-infective agents</subject><subject>Anti-Infective Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Antimicrobial agents</subject><subject>Antimicrobial Stewardship</subject><subject>Biology and Life Sciences</subject><subject>Ceftriaxone</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Clinical outcomes</subject><subject>Cloxacillin</subject><subject>Colistin</subject><subject>Consumption</subject><subject>Data collection</subject><subject>Dosage and administration</subject><subject>Drug resistance</subject><subject>Drug resistance in 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critically ill children admitted to the Paediatric Intensive Care Unit (PICU). The antimicrobial use data from Indian PICUs is limited using standard metrics such as Days of therapy (DOT). This study aimed to determine the baseline trend of antimicrobial use in PICU of a tertiary care teaching hospital of Raipur district of Chhattisgarh, India using standard metrics with the goal of developing facility-wide antibiotic policy and strengthening the antimicrobial stewardship activities. This active surveillance was conducted over a period of 18 months, from November 1, 2019, to March 21, 2021, in patients aged one month to 14 years who were admitted for ≥ 48 hours to the PICU at a tertiary care teaching hospital of Raipur District. Data on patient characteristics, antimicrobial indications, antimicrobial prescription information, and clinical outcomes were collected using pre-designed data abstraction forms. The descriptive statistic was used to represent the results. The antimicrobial consumption was analyzed according to the WHO AWaRe Class (Access, Watch, and Reserve groups) of antibiotics. The antimicrobial consumption was expressed as DOT/1000 patient-days (PD). A total of 216 patients were surveyed during the study period. The average number of antimicrobials prescribed per hospitalisation was 2.60 (range: 1-12), with 97.22% administered via parenteral route. Overall, DOT/1000-PD was 1318. The consumption of Watch Group antimicrobials was highest with 949 DOT/1000-PD, followed by Access (215) and Reserve Group (154), respectively. Ceftriaxone (208 DOT/1000 PD) was the most commonly prescribed antimicrobial agent, followed by Vancomycin (201), Meropenem (175), Piperacillin-Tazobactam (122) and Colistin (91). The patients who were escalated (28.24%) from empirical antimicrobial therapy had longer median PICU stay (8 days) compared those who were de-escalated (23.6%). Targeted therapy was given in 10.2% patients. The overall mortality rate was 14.35% and was higher (29.3%) in patients in whom empirical therapy was escalated compared to those who were de-escalated or continued. The study established a benchmark for antimicrobials use in the PICU and highlighted priority areas for antimicrobial stewardship intervention to enhance de-escalation rates, enhance targeted therapy, and reduce the overuse of antimicrobials especially belonging to the reserve group.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>39298455</pmid><doi>10.1371/journal.pone.0310515</doi><tpages>e0310515</tpages><orcidid>https://orcid.org/0000-0003-0064-0019</orcidid><orcidid>https://orcid.org/0000-0003-0295-3262</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2024-09, Vol.19 (9), p.e0310515 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_3106994248 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Adolescent Anti-Bacterial Agents - therapeutic use Anti-infective agents Anti-Infective Agents - therapeutic use Antibiotics Antimicrobial agents Antimicrobial Stewardship Biology and Life Sciences Ceftriaxone Child Child, Preschool Clinical outcomes Cloxacillin Colistin Consumption Data collection Dosage and administration Drug resistance Drug resistance in microorganisms Female Health aspects Hospitals Humans India Infant Intensive care Intensive Care Units, Pediatric Length of stay Male Medical care Medical research Medicine and Health Sciences Medicine, Experimental Meropenem Mortality Nosocomial infections Patients Pediatric intensive care Pediatrics Piperacillin-tazobactam Prevention Quality management Strengthening Tazobactam Tertiary Care Centers Therapy Vancomycin |
| title | "Antimicrobial utilization in a paediatric intensive care unit in India: A step towards strengthening antimicrobial stewardship practices" |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-31T00%3A43%3A56IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=%22Antimicrobial%20utilization%20in%20a%20paediatric%20intensive%20care%20unit%20in%20India:%20A%20step%20towards%20strengthening%20antimicrobial%20stewardship%20practices%22&rft.jtitle=PloS%20one&rft.au=Singh,%20Madhusudan%20Prasad&rft.date=2024-09-19&rft.volume=19&rft.issue=9&rft.spage=e0310515&rft.pages=e0310515-&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0310515&rft_dat=%3Cgale_plos_%3EA809263270%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3106994248&rft_id=info:pmid/39298455&rft_galeid=A809263270&rfr_iscdi=true |