Caroline Nandita, E (2020) A Study of Antibiotic De-Escalation Practices in Medical Wards in a Teaching Hospital. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: Antimicrobial resistance has been identified as a global health hazard with serious implications. It is usually associated with significant higher morbidity, mortality, prolongation of illness and reduced labor efficiency. Resistance is thought to be a reaction of the organism for survival, developing mutations that enable it to exist in hostile environments which include antibiotic exposure. Organisms develop mutations which are then transmitted by horizontal gene transfer and this results in the formation of a resistant population. De-escalation of antibiotics is a mechanism that has been described to prevent unnecessary use of antibiotics and thus reduce the development of resistance. It has been shown to reduce mortality and reduction in overall antibiotic related side effects. OBJECTIVE: To determine the proportion of patients in whom antibiotic de-escalation was implemented and factors associated with it. A qualitative study to understand perceptions of PG medical doctors was also conducted. METHODS: This prospective study was conducted among patients who were admitted and started on empirical antibiotic therapy in all Medical wards- C, I, E, MTS4 excluding Medical ICU and HDU at Christian Medical College Vellore. The patients in whom an opportunity presented to de-escalate were further followed up to assess for de-escalation. We analysed the reasons associated with de-escalation of antibiotics by univariate analysis. The qualitative study was carried out using a semi structured questionnaire among the General medicine Post graduate students. RESULTS: From September 2018 to May 2019, we found 183 patients who fulfilled our inclusion criteria.116 (63.4%) of patients underwent de-escalation. There was a significant p value of 0.034 favoring de-escalation when the SOFA score was more than 2(OR 95% CI, 1.032-13.005). In our qualitative study we were able elicit the challenges and perceptions of our postgraduate in the process of antibiotic prescribing and towards antimicrobial stewardship. The thematic analysis showed the emergence of four major themes: awareness of increasing antimicrobial resistance causes for antimicrobial resistance, antimicrobial prescribing practices and ways to improve the antibiotic stewardship. CONCLUSIONS: The major reasons for non-de-escalation that we found were initial presentation of severe sepsis, lack of improvement on appropriate antibiotic therapy, suspicion of concurrent bacterial infection which had not been detected in cultures and growth of an organism which was not covered by the initial therapy. In our qualitative study we were able elicit the challenges and perceptions of our postgraduate in the process of antibiotic prescribing and towards antimicrobial stewardship. This study broadens the scope of research on prescribing behaviors and extends our understanding of how to optimize them.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 201711453 |
| Uncontrolled Keywords: | Antibiotic De-Escalation Practices, Medical Wards, Teaching Hospital. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 28 Jan 2021 18:57 |
| Last Modified: | 31 Jan 2021 03:30 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13345 |
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