KOCHI: At a time when antibiotic resistance is emerging as a major public health issue, the antimicrobial resistance (AMR) containment programme at the General Hospital (GH) has found that 27% of the total infectious patients could be cured of their illnesses using baseline antibiotics.
Another 29% patients were de-escalated to the right antibiotic, even as they were put on higher antibiotics earlier. In case of 44% patients, the doctors had to escalate the antibiotic dose to the next level.
The AMR programme, which is part of the Sepsis Management Project of the State Health Services, was implemented through public-private partnership (PPP) with BD India using an automated blood culture machine. Around 56% cases were cured through the procedure in which first-level antibiotics were used.
The exercise demonstrated judicious use of antibiotics in controlling infectious diseases, said Sivaprasad P.S., nodal officer of the programme.
“A clinical audit of six months at the Sick Newborn Care Unit (SNCU) at the hospital showed that there was an average reduction of 44 hours stay in the hospital,” he added. Antibiotic resistance arises due to indiscriminate use of antibiotics resulting in microbes becoming resistant to the available spectrum of antibiotics.
GH is likely to be selected for a national AMR surveillance programme by the National Centre for Disease Control. The programme will be implemented through medical colleges.“The automated machines used at GH reduce detection time, besides increasing detection rate,” said Dr. Sivaprasad. During the last one-and-a-half years after the programme was implemented, as many as 1,891 samples were tested, of which 162 were positive. The manual detection rate is 2% to 3%, while the automated rate is close to 8.6%.
Of the total 162 infectious patients, 127 were cured of their illnesses. The patients belonged to the neonatal intensive care unit (NICU), SNCU, MICU, and departments like medicine, nephrology, paediatrics, gynaecology, and oncology. The cure rate was found to be 78% as against the usual rate of sepsis cases in which 50% become fatal.
Early detection
The major advantage of the programme is the early detection of microbes in four to six hours and the availability of culture report in 48 hours, said Dr. Junaid Rahman, advisor to the programme and the Hospital Development Society.
The programme has helped clinicians choose first-line antibiotics like Ampicillin to higher-end ones like Meropenam and Colistin judiciously in sepsis cases. Higher-end antibiotics were also used in a few cases, especially oncology and nephrology cases, in which resistant organisms were found.Clinical microbiologist R.V. Arya had supervised the microbiology back-up, which is an important aspect of AMR containment. It is this support that gives clinicians the confidence to de-escalate the antibiotic to a lower level, said Dr. Sivaprasad.
