Research Article

Results of Antimicrobial De-escalation with a Focus on Antimicrobial Utilisation at a Tertiary Care Hospital in South India

Abstract

Background: Research and literature about antimicrobial de-escalation frequently focus on evaluating the safety and efficacy of de- escalation in infected patients, rather than on antibiotic utilisation itself. Evidence indicates that the primary intervention to prevent the further evolution of antimicrobial resistance (AMR) is to enhance antimicrobial deescalation and refine antimicrobial stewardship (AMS) techniques. An audit of antibiotic use in infections and the assessment of antibiotic consumption constitutes the fundamental aspect of Antimicrobial Stewardship Programs (AMSP). This study sought to evaluate the clinical consequences of antibiotic de-escalation concerning length of stay (LOS), duration of intravenous antibiotics, as well as antibiotic utilisation and therapy duration. Methods: This prospective observational study encompassed in-patients receiving antibiotic prescriptions. Data gathered encompassed patient demographics, antibiotic regimens (empiric, de-escalated, or non-de-escalated), microbiological findings, and final diagnoses. The results of de-escalation and non-de-escalation were analysed. Statistical analysis was conducted with SPSS software, with a p value of less than 0.05% deemed significant. Results: Among the 360 patients, 226 underwent therapy de-escalation, whereas 134 experienced non-de-escalation of their treatment. The de-escalated population exhibited a reduced length of stay (mean: 4 days vs. 6 days, p < .05), a shorter duration of therapy (mean: 11.3 days vs. 13.9 days, p = .05), and fewer days on intravenous antibiotics (median: 3 days vs. 5 days, p = .05) in comparison to the non-de-escalated group. Conclusion: Deescalation yielded a: Reduction of 2.6 Days of Therapy (DOT) units of antibiotic usage (p value = 0.05), despite comparable lengths of antimicrobial treatment (LOT). Reduction of two days of intravenous antibiotic therapy (p value = 0.05). Decrease of 1.7 days in hospital length of stay (p value < .05)