UTILIZATION PATTERN OF ANTIMICROBIALS AMONG PATIENTS UNDERGONE MIDLINE LAPAROTOMY IN FOUR TERTIARY CARE TEACHING HOSPITALS OF GUJARAT, INDIA: MULTI-CENTRIC RETROSPECTIVE STUDY

Abstract

Objectives:

To analyse utilization patterns of antimicrobials and impact of different wound types and indications of midline laparotomy for its use

Materials and Methods:

Indoor case papers of the patients undergone midline laparotomy were analysed for demographic variables; type of surgery; wound type; indications; utilization (DDD/100 bed-days) and cost of antimicrobials; wound infections; duration of stay; organism isolated and their antimicrobial sensitivity and outcome of the patient.

Results:

Total 466 cases were evaluated with median hospital stay of 11 days. Metronidazole (90.55percent), amikacin (64.8percent), ceftriaxone (58.8percent) and ciprofloxacin (18.66percent) were commonly used antimicrobials. Ceftriaxone + metronidazole (52.36percent) were the most common empirical regimen used. Most common isolated organisms were Escherichia coli 20 (28.17percent) out of 71 isolated organisms in 52 cases. Amikacin and pipracillin+tazobactam have shown good sensitivity against all isolated organisms except A. baumanii. A significantly higher number of antimicrobials, their cost and duration of stay were noted in surgical site infection (SSI) cases, as especially in small bowel perforation cases.

Conclusion: SSI increases cost, antimicrobial use and resistance. Proper sanitation, hygiene and postoperative care are utmost important tools to deal with growing resistance by preventing SSI.

Key words: Utilization pattern, Antimicrobials, Midline laparotomy, Surgical site infection, Retrospective study.