Antimicrobial Audit and Stewardship Practices among Hospitalised Patients: A Retrospective Study

Abstract

Background: Empirical broad-spectrum antibiotic use leads to misuse, side effects, antimicrobial resistance, and higher costs. This necessitates antimicrobial stewardship programs (AMSP) to promote judicious antibiotic use. This study aimed to analyze antibiotic prescription patterns and culture request frequencies in surgical wards and intensive care units (ICU). Methodology: This retrospective study by the department of Microbiology in a tertiary care hospital was undertaken in surgical wards and ICUs. Data on baseline characteristics, antibiotic usage, and culture requests were collected. The microbiology laboratory used Kirby-Bauer disk diffusion for antimicrobial testing. An infection control nurse audited antibiotic administration. Results: This retrospective study spanned eight months (June 2023 to January 2024) and included 1018 patients from surgical wards and ICUs. Of the 1018 patients, 83.8% were male, with 52% aged 21-40 years. Confirmed infections were found in 25% of patients, predominantly Gram-negative bacteria (94.2%). The most common organisms were Escherichia coli (72.2%), Klebsiella pneumoniae (10.19%), and Pseudomonas aeruginosa (5.8%). Cephalosporins were the most prescribed antibiotics (89.7%). Only 41.5% of antibiotic prescriptions matched culture sensitivity reports, with 58.5% inappropriately prescribed. Hospital stays were under 15 days mostly (86%). Conclusion: Empirical antibiotic use is prevalent, with infrequent culture-based adjustments. Only 41.5% of antibiotics matched culture reports. AMSPs and education on stewardship principles are essential to address inappropriate antimicrobial use.