(256) Evaluation of Antimicrobial Stewardship Metrics in General Surgery Wards

Background: The escalating threat of antimicrobial resistance (AMR) necessitates effective antimicrobial stewardship programs (ASPs) to ensure the judicious use of antibiotics, especially in hospital settings where the risk of infection and subsequent antibiotic use is high. General surgery wards, in particular, are critical areas due to the frequent need for antimicrobial prophylaxis and therapy, presenting unique challenges for antimicrobial management. antimicrobial stewardship metrics evaluations are crucial for identifying trends, optimizing antibiotic use, and minimizing the development of resistance.

Objectives: To evaluate the antimicrobial stewardship metrics among the patients admitted to the general surgery wards.

Methods: A prospective study was carried out in the surgery wards of a tertiary care hospital for six months. Patients of either gender who received at least one antimicrobial agent, with a hospital stay of more than 24 hours and aged ≥ 18 of age were included in the study after obtaining their informed consent. Terminally ill patients, medico-legal cases, patients being transferred to another department and patients discharged against medical advice (DAMA) were excluded. The antimicrobial metrics analyzed were - Daily Defined Dose (DDD), Days of Therapy (DOT), Length of Therapy (LOT), Antimicrobial Free Days, and antimicrobial resistance trends. Wilcoxon signed-rank test was used to compare DDD vs DOT values. The data obtained was assessed categorically.

Results: Of 554 patients admitted, 217 (29.16%) were eligible and included. Of the 217 patients 125 (57.60%) were males and 92 (42.40%) were females. The mean age and length of stay was 47.2 ± 16.66 years and 7.03 ± 3.25 days respectively. The mean total antimicrobial usage is measured by the number of DDDs per 1000 patient days and DOTs per 1000 patient days was found to be 6273.919 ± 7842.411 and 4491.776 ± 1665.571, respectively. In the 36 commonly used antimicrobial drugs the difference between the DDDs and DOTs was classified as major [24 (77.42%)], moderate [5 (16.13%)], and minor [7 (22.58%)]. The LOT and antimicrobial resistance trends were 8271.89 LOT per 1000 patient days and 9.21%.

Conclusions: Antimicrobial stewardship programs play a vital role in the rational prescribing of antimicrobial agents. Clinical pharmacists are critical in the implementation of an ASP through involvement in monitoring, etc. Most antimicrobials used in this study have differing DDDs/1000 patient-days and DOTs/1000 patient-days because administering dose is dissimilar from WHO-assigned DDD.