Antimicrobial consumption and impact of “Reserve antibiotic indent form” in an intensive care unit

OBJECTIVE: To study the antimicrobial (AM) consumption, record the AM sensitivity pattern, and evaluate impact of “Reserve AM indent form” in the intensive care unit (ICU). MATERIALS AND METHODS: The study was carried out in medical ICU over 4 months period at a tertiary care hospital. AM consumption was determined by defined daily dose (DDD) per 100 bed days for each month for consecutive 4 months. The average total AM consumption was calculated. The laboratory samples were processed, and the sensitivity pattern was determined. Some of the newer AM were categorised as “Reserve” and an indent form was made mandatory to be filled up prior to prescription. RESULTS: The total AM consumption was 232 per 100 bed days. The commonly used AM were penicillin with β-lactamase inhibitor (21%) followed by antifungal drugs (13.4%), cephalosporins and macrolides (11.7%) each. The most common organism isolated was Acinetobacter (26.1%) followed by Candida (23.8%) and Pseudomonas (21.4%). The average occupancy index was 0.53, and the average duration of ICU stay was 6 days. The consumption of carbapenems (new AM) and antifungals decreased from 18.8/100 to 10.6/100 and 56.1/100 to 22.1/100 bed days, respectively, after the introduction of indent form. CONCLUSION: The “Reserve AM indent form” was helpful in reducing the AM consumption during the study period. The AM indent form can be used as an important tool to combat irrational use, AM resistance and can be implemented in AM stewardship programmes.