John Preshanth Kumar Pathiraj 1, Manjunatha H Hande 2, Murulidhar Varma 2, Chiranjoy Mukhyopadhay 3, Roshan David Jathanna 4, Menino Osbert Cotta (Os) 5, Abdul Ghaffur 6
1 Dept. of Pharmacy Practice, Manipal College Of Pharmaceutical Sciences, Manipal Univerisity, Manipal, Udupi, Karnataka, India
2 Dept. of Medicine Kasturba Medical College Manipal Univerisity, Manipal, Udupi, Karnataka, India
3 Dept. of Microbiology Kasturba Medical College Manipal Univerisity, Manipal, Udupi, Karnataka, India
4 Dept. of Computer Science & Engineering Manipal Institute of Technology Manipal Univerisity, Manipal, Udupi, Karnataka, India
5 Department of Intensive Care Medicine, Ned Hanlon Building, Royal Brisbane and Women’s Hospital, Herston, Qld, Australia
6 Apollo Specialty Hospital, Padma Complex, Anna Salai, Chennai, Tamil Nadu, India
Introduction:
Antimicrobial stewardship program is an effective approach widely acknowledged comprising multiple strategies is advocated to overcome adverse outcomes of antimicrobial resistance.
The objective of the study was to develop a clinical decision support system(CDSS) to record antimicrobial utilization in the ICUs.
Methods:
This is a single centre “before-after” interventional study in a Medicine ICU patients at Kasturba Hospital, Manipal, Karnataka, India approved by the IEC
Results:
Development of eCRF (AU-Crit):Was written using C#. As a pilot, 50 patient’s study variables as per inclusion criteria were recorded in the eCRF with Xcel database and analysed. Male predominance with 68%, the median age were 61 (IQR 53-70) were observed. Microbiology isolates (%) from blood, ET-aspirate and Urine for ESKAPE organisms. The pre-dominant culture-positive results were Klebisiella and Enterobacter (10% each), Acenetobacter(14%) and Enterobacter(10%) while 27%, 20% and 12% of them tested culture negative respectively.
Mean Charlston Co-morbidity index and serum protein were 2.6(0.96±SD) and 3.1(0.7±SD) respectively.
Diagnoses were BSI-45%,HAP-35%, Urosepsis-10%,CAP-5% and Aspiration Pneumonia-5%. Kunin’s Appropriateness criteria was highest for Cat II and Cat V with 27% each, 30% got definitive therapy and de-escalation in 72%. Mean LOS was 8 (IQR 4-15), APACHE II-38, SOFA-14 and TISS-28 score-20.
Mean DOT/ 1000 patient days for restricted antimicrobials were Colistin-34.5,Meropenam-16,Vancomycin-10,Teicoplanin-16,Pip-Tazo-98, Cefoperozone+Sulbactum-68 with a mean Direct ICU cost /patient (US$) was-Ventilated:620 and Non-Ventilated:340.
CONCLUSION & FUTURE WORK
Data collection for the PreCDSS implementation period using AU-Crit is currently underway and the CDSS is on developmental stage with SQLite database for data storage and security.