AN AUDIT OF ANTIBIOTIC USAGE AND ITS CONCORDANCE WITH THE SENSITIVITY PATTERN FOLLOWING EMERGENCY ABDOMINAL SURGERY.
Gurushankari Balakrishnan*1, Misha Madan1, Dhanajayan Govindan2, Lekshmi Satheesh1, Thulasingam Mahalakshmy2, Sathasivam Sureshkumar1, Vikram Kate1
1Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India; 2Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research., Pondicherry, India
Introduction: This study aims to audit the antibiotic usage and its concordance with the sensitivity pattern following emergency abdominal surgeries and to measure and record the antibiotics administered within the first hour of admission.
Methods: This longitudinal study comprised a single group of patients above 18 years of age, who underwent emergency abdominal surgeries in a tertiary care center in South India. The sensitivity pattern of the organisms was noted, based on the results of blood, wound discharge, or intra operative fluids, sent as a part of routine care. The concordance of antibiotics administered with the sensitivity patterns was noted in the proforma. In case of cultures being sterile, the given patient was not included in the subgroup analysis for concordance or discordance.
Results: A total of 97 patients were included in the study between March 2021 and September 2021. In 87.63% of the cases i.e. 85 patients out of 97, antibiotics were administered at least one hour before the surgery. In 84.54% of the patients, preoperative antibiotics were continued, which included cases of both concordance and discordance with the results of culture sensitivity. It also included some of the cases where culture sensitivity was not sent. After excluding the cases where culture was not sent for sensitivity testing , cases where second line antibiotics were not administered or first line antibiotic stopped before hospital discharge, 62 patients were evaluated for concordance or discordance of culture report. Out of the 97 patients included for the study, in 36.08% cases, the antibiotic administered was concordant while in 27.84% cases, discordant. In 82.26% patients out of 62, the pre operatively administered antibiotic was discordant. If compared to the second line antibiotics, the discordance in that case was 43.55%. Out of the total cultures that came concordant, 57.14% of them were concordant for the second line antibiotics while 42.86% of the cultures were concordant for the first line antibiotics. Out of the total discordant cultures, in 62.96% of the cases, the first line antibiotics were continued despite discordance while in 37.04% cases, second line antibiotics were administered despite the proven discordance. Maximum resistance among antibiotics was found against minocycline (80%), followed by ceftazidime (73.45%) and ciprofloxacin (73.45%).
Conclusion: In 85 patients, the antimicrobials were administered at least 1 hour before the surgery. Concordance of antimicrobial usage was seen in 36.08% of the cases. The highest resistance was recorded against minocycline followed by cefotaxime, a third-generation cephalosporin and ciprofloxacin, a fluoroquinolone. The most commonly isolated organism isolated in the culture was Escherichia coli, followed by Klebsiella pneumoniae.
Table 1: Antimicrobial administration pattern.
Table 2: Antibiotics versus Sensitivity pattern
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