Compliance to 4Ds of antimicrobial stewardship practices in a tertiary care centre

Abstract

AbstractBackgroundIndiscriminate use of antimicrobials has been a cause of concern worldwide in recent years because of the potential to give rise to antimicrobial resistance and difficult to treat infections. Antimicrobial Stewardship describes the practice of promoting the selection of the right drug, dosage, delivery route, and duration of antimicrobial therapy (4Ds) to curtail these concerns. Nevertheless, it is important to quantify the magnitude of the problem in terms of the percentage of adherence with respect to each of the 4Ds described above. This will aid in the identification of areas for potential interventions to improve use.MethodsWe undertook a prospective review of the medical records of patients admitted in the medicine wards of a tertiary care centre in Northern India. All those patients who were prescribed on antimicrobials were included and their records reviewed for the indication, drug, dose, delivery, and duration (or by asking the treating physician if not documented). Adherence to the guidelines was determined by referring to the updated literature (local, national, or international standard treatment guidelines or textbooks) for each specific disease condition.ResultsOf the total 304 patients, the choice of drugs was appropriate and matched the guidelines in 218 (72%) patients. Adherence to the right dose in 210 (69%), route of delivery in 216 (71%), and to duration in 197 (65%) were observed. Full adherence to all the above mentioned parameters was observed in 196 (64.5%). Maximum adherence was observed in the treatment of skin and soft tissue infections (100 %) while minimum adherence was observed while administering medical prophylaxis (40 %). Among the non-adherents, over-prescription was observed in 10 (3.3 %), under-prescription in 12 (3.9 %), choice was inappropriate in 46 (15.1 %) and in 30 (10 %) patients, antimicrobials were not indicated but prescribed.ConclusionInternist practices antimicrobial stewardship with respect to the prevalent guidelines for right prescription in 2/3rd admitted patients, a sub-optimal one. Right drug, dose, delivery route, duration of therapy are practiced in 72%, 69%, 71%, and 65% patients respectively. To increase adherence to 100%, bedside stewardship practices in form of prospective audit and feedback must be improved.