Ten-year trends of antibiotic prescribing in surgery departments of two private sector hospitals in Central India: a prospective observational study
Abstract Background Inappropriate antibiotic use contributes to the global rise of antibiotic resistance, prominently in low- and middle-income countries, including India. Despite the considerable risk of surgical site infections, there is a lack of antibiotic prescribing guidelines and long-term st...
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| Format: | Article |
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BMC
2024-01-01
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| Series: | BMC Public Health |
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| Online Access: | https://doi.org/10.1186/s12889-024-17817-2 |
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| author | Kristina Skender Anna Machowska Shyam Kumar Dhakaita Cecilia Stålsby Lundborg Megha Sharma |
| author_facet | Kristina Skender Anna Machowska Shyam Kumar Dhakaita Cecilia Stålsby Lundborg Megha Sharma |
| author_sort | Kristina Skender |
| collection | DOAJ |
| description | Abstract Background Inappropriate antibiotic use contributes to the global rise of antibiotic resistance, prominently in low- and middle-income countries, including India. Despite the considerable risk of surgical site infections, there is a lack of antibiotic prescribing guidelines and long-term studies about antibiotic prescribing in surgery departments in India. Therefore, this study aimed to analyse 10 years’ antibiotic prescribing trends at surgery departments in two tertiary-care hospitals in Central India. Methods Data was prospectively collected from 2008 to 2017 for surgery inpatients in the teaching (TH-15,016) and the non-teaching hospital (NTH-14,499). Antibiotics were classified based on the World Health Organization (WHO) Access Watch Reserve system and analysed against the diagnoses and adherence to the National List of Essential Medicines India (NLEMI) and the WHO Model List of Essential Medicines (WHOMLEM). Total antibiotic use was calculated by DDD/1000 patient days. Time trends of antibiotic prescribing were analysed by polynomial and linear regressions. Results The most common indications for surgery were inguinal hernia (TH-12%) and calculus of the kidney and ureter (NTH-13%). The most prescribed antibiotics were fluoroquinolones (TH-20%) and 3rd generation cephalosporins (NTH-41%), and as antibiotic prophylaxis, norfloxacin (TH-19%) and ceftriaxone (NTH-24%). Access antibiotics were mostly prescribed (57%) in the TH and Watch antibiotics (66%) in the NTH. Culture and susceptibility tests were seldom done (TH-2%; NTH-1%). Adherence to the NLEMI (TH-80%; NTH-69%) was higher than adherence to the WHOMLEM (TH-77%; NTH-66%). Mean DDD/1000 patient days was two times higher in the NTH than in the TH (185 vs 90). Overall antibiotic prescribing significantly increased in the TH (β1 =13.7) until 2012, and in the NTH (β2 =0.96) until 2014, and after that decreased (TH, β2= -0.01; NTH, β3= -0.0005). The proportion of Watch antibiotic use significantly increased in both hospitals (TH, β=0.16; NTH, β=0.96). Conclusion Total antibiotic use decreased in the last three (NTH) and five years (TH), whereas consumption of Watch antibiotics increased over 10 years in both hospitals. The choice of perioperative antibiotic prophylaxis was often inappropriate and antibiotic prescribing was mostly empirical. The results of this study confirmed the need for antibiotic prescribing guidelines and implementation of antimicrobial stewardship programs. |
| first_indexed | 2024-03-07T15:25:42Z |
| format | Article |
| id | doaj.art-66786ba84b5046719d3c0c06c710a733 |
| institution | Directory Open Access Journal |
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| language | English |
| last_indexed | 2024-03-07T15:25:42Z |
| publishDate | 2024-01-01 |
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| spelling | doaj.art-66786ba84b5046719d3c0c06c710a7332024-03-05T17:08:01ZengBMCBMC Public Health1471-24582024-01-0124111410.1186/s12889-024-17817-2Ten-year trends of antibiotic prescribing in surgery departments of two private sector hospitals in Central India: a prospective observational studyKristina Skender0Anna Machowska1Shyam Kumar Dhakaita2Cecilia Stålsby Lundborg3Megha Sharma4Department of Global Public Health, Health Systems and Policy, Karolinska InstitutetDepartment of Global Public Health, Health Systems and Policy, Karolinska InstitutetDepartment of Surgery, Ruxmaniben Deepchand Gardi Medical CollegeDepartment of Global Public Health, Health Systems and Policy, Karolinska InstitutetDepartment of Global Public Health, Health Systems and Policy, Karolinska InstitutetAbstract Background Inappropriate antibiotic use contributes to the global rise of antibiotic resistance, prominently in low- and middle-income countries, including India. Despite the considerable risk of surgical site infections, there is a lack of antibiotic prescribing guidelines and long-term studies about antibiotic prescribing in surgery departments in India. Therefore, this study aimed to analyse 10 years’ antibiotic prescribing trends at surgery departments in two tertiary-care hospitals in Central India. Methods Data was prospectively collected from 2008 to 2017 for surgery inpatients in the teaching (TH-15,016) and the non-teaching hospital (NTH-14,499). Antibiotics were classified based on the World Health Organization (WHO) Access Watch Reserve system and analysed against the diagnoses and adherence to the National List of Essential Medicines India (NLEMI) and the WHO Model List of Essential Medicines (WHOMLEM). Total antibiotic use was calculated by DDD/1000 patient days. Time trends of antibiotic prescribing were analysed by polynomial and linear regressions. Results The most common indications for surgery were inguinal hernia (TH-12%) and calculus of the kidney and ureter (NTH-13%). The most prescribed antibiotics were fluoroquinolones (TH-20%) and 3rd generation cephalosporins (NTH-41%), and as antibiotic prophylaxis, norfloxacin (TH-19%) and ceftriaxone (NTH-24%). Access antibiotics were mostly prescribed (57%) in the TH and Watch antibiotics (66%) in the NTH. Culture and susceptibility tests were seldom done (TH-2%; NTH-1%). Adherence to the NLEMI (TH-80%; NTH-69%) was higher than adherence to the WHOMLEM (TH-77%; NTH-66%). Mean DDD/1000 patient days was two times higher in the NTH than in the TH (185 vs 90). Overall antibiotic prescribing significantly increased in the TH (β1 =13.7) until 2012, and in the NTH (β2 =0.96) until 2014, and after that decreased (TH, β2= -0.01; NTH, β3= -0.0005). The proportion of Watch antibiotic use significantly increased in both hospitals (TH, β=0.16; NTH, β=0.96). Conclusion Total antibiotic use decreased in the last three (NTH) and five years (TH), whereas consumption of Watch antibiotics increased over 10 years in both hospitals. The choice of perioperative antibiotic prophylaxis was often inappropriate and antibiotic prescribing was mostly empirical. The results of this study confirmed the need for antibiotic prescribing guidelines and implementation of antimicrobial stewardship programs.https://doi.org/10.1186/s12889-024-17817-2Antibiotic prescribing trendsAWaReSurgeryPrivate sector hospitalsTeaching hospitalNon-teaching hospital |
| spellingShingle | Kristina Skender Anna Machowska Shyam Kumar Dhakaita Cecilia Stålsby Lundborg Megha Sharma Ten-year trends of antibiotic prescribing in surgery departments of two private sector hospitals in Central India: a prospective observational study BMC Public Health Antibiotic prescribing trends AWaRe Surgery Private sector hospitals Teaching hospital Non-teaching hospital |
| title | Ten-year trends of antibiotic prescribing in surgery departments of two private sector hospitals in Central India: a prospective observational study |
| title_full | Ten-year trends of antibiotic prescribing in surgery departments of two private sector hospitals in Central India: a prospective observational study |
| title_fullStr | Ten-year trends of antibiotic prescribing in surgery departments of two private sector hospitals in Central India: a prospective observational study |
| title_full_unstemmed | Ten-year trends of antibiotic prescribing in surgery departments of two private sector hospitals in Central India: a prospective observational study |
| title_short | Ten-year trends of antibiotic prescribing in surgery departments of two private sector hospitals in Central India: a prospective observational study |
| title_sort | ten year trends of antibiotic prescribing in surgery departments of two private sector hospitals in central india a prospective observational study |
| topic | Antibiotic prescribing trends AWaRe Surgery Private sector hospitals Teaching hospital Non-teaching hospital |
| url | https://doi.org/10.1186/s12889-024-17817-2 |
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