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