Author: David Thomas 1 2, Vijayvardhan Kamalumpundi 3, Amirtha Thampi 4, Kashelle Lockman 5, Mary B Carter 1, Navjyot Vidwan 1, Ann Broderick 3 6
Journal: Antimicrob Steward Healthc Epidemiol. 2023 Nov 8;3(1):e196. doi:10.1017/ash.2023.468. eCollection 2023
Abstract:
Objective: Characterize antibiotic prescribing behaviors at an Indian palliative care center after the initiation of the Antibiotic Order Form (AOF): an antibiotic stewardship
program involving a paper form to track antibiotic use and to provide prescription guidelines.
Design: Retrospective chart review.
Setting: Trivandrum Institute of Palliative Sciences (TIPS) is a palliative care
organization in Kerala, India.
Methods: Antibiotic prescription data and patient data were collected for adult patients
treated at TIPS between January 1, 2017, and October 31, 2019. Descriptive statistics
and a Zero-Inflated Poisson regression model were used to analyze antibiotic
prescriptions. AOF completion and prescription concordance with institutional guidelines
were also evaluated.
Results: Out of 7,450 unique patients, 675 (9%) were prescribed 1,448 antibiotics. Age
was the strongest factor in determining the number of antibiotic courses with each
additional year of age decreasing the expected antibiotic prescription count by 2% per
year. The most common antibiotics prescribed were topical metronidazole (44%) and
penicillins (29%). Among patients who died, 5% were prescribed antibiotics within the
final month of life. In total, 32% of antibiotic prescriptions were documented in AOFs,
and 18% were concordant with all institutional antibiotic prescribing guidelines.
Conclusions: This study is the first to analyze an antibiotic stewardship intervention in a
palliative care setting within a low- and middle-income country. This retrospective study
provides a benchmark of antibiotic use within Indian palliative care and highlights areas
for future stewardship research including topical metronidazole use within palliative care
and higher rates of antibiotic use among younger palliative care patients.
Access full article: https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/38028900/