A prospective study on evaluation of antibiotic prescription practices in an intensive care unit of a tertiary care hospital

Objective: Antibiotics are the most commonly prescribed drugs in hospitals and their irrational use is one of the important factors for the development and spread of resistance in the hospitals. The prescribing of antibiotics in the Intensive care unit (ICU) is usually empirical, given the critical condition of the patients who are hospitalized there. Since there is wide diversity in the prevalence of predominant pathogens and their antimicrobial susceptibilities, especially within individual ICUs, there is a need to formulate appropriate prescription practices, based on studies and research within the ICUs. Therefore, an audit of the antibiotic prescription practices in our Intensive care unit was planned. Design: Prospective Hospital based cross sectional study Setting: Intensive care unit of a tertiary care centre (Kasturba Medical College Hospital, Attavar, Mangalore) Patients: All patients receiving a therapeutic antibiotic for the linical suspicion of bacterial infections through to ICU discharge were included. Interventions: Data was collected on patient demographics, date of the hospital and ICU admission, reason for the ICU admission, white cell count and the proposed site of infection. Results: The respiratory system was the single most common site for infections in the ICU. Infections caused by Gram negative organisms were more common than those caused by Gram positive organisms. Antibiotics were administered empirically in 64% of the cases and in the rest, after microbiological confirmation. Conclusions: The inappropriate and ineffective use of antibiotics is commonly observed in the health care system, especially in developing countries. In 32.03% of the patients who are treated on an empirical basis, microbiological reports on the antibiotic susceptibility patterns were contrary to the treatment which was given. Hence, there is a compelling reason to change the current prescribing practices by a multidisciplinary approach, in order to curtail the spread of multi-resistant pathogens in the ICUs.