Antimicrobial usage in post operative patients in general surgery wards and intensive care units of a tertiary care hospital in central India: an ATC/DDD-based observational study

Abstract

Background: The rise of antimicrobial resistance (AMR) is a major global health concern, due to inappropriate use of antibiotics. General surgery wards and intensive care units (intensive care units), are high-risk areas due to frequent use of antimicrobials for postoperative prophylaxis and treatment. This study focuses on assessing antimicrobial consumption patterns in postoperative patients using the world health organization (WHO) anatomical therapeutic chemical/defined daily dose (ATC/DDD) system. Methods: A prospective, observational study was conducted over 12 months in the general surgery unit of tertiary care hospital. Antimicrobial usage data were collected from postoperative patients using WHO’s ATC/DDD methodology and expressed as DDD/100 bed-days. Descriptive statistics were used for analysis, and ethical approval was obtained prior to study initiation. Results: Out of 600 participants enrolled, majority were males (64.5%), 49.66% were in 18-40 age group, and majority (69.33%) were from rural areas. Most patients (47.5%) were prescribed two antibiotics. A total of nine antibiotics were commonly prescribed, with inj. metronidazole being the most frequently used (35.8%), followed by inj. amoxicillin + clavulanic acid (24.3%) and inj. cefotaxime (12.0%). According to WHO ATC/DDD methodology, inj. metronidazole showed the highest antibiotic consumption at 14.96 DDD/100 bed-days, followed by inj. amoxicillin + clavulanic acid at 7.17 DDD/100 bed-days. Conclusions: Study highlights extensive antibiotic use (99.66%) in postoperative patients, with a predominance of injectable drugs (86.07%). Average of 2.12 antibiotics per patient suggests a trend toward broad-spectrum prophylaxis, raising concerns about costs, adverse effects, and resistance. The findings underscore the need for prescription audits and antimicrobial stewardship to improve rational and cost-effective drug use