Research
Assessment of Clinicians Knowledge and Perception on Antimicrobial Resistance a Primary Strategy for Antimicrobial Resistance Control
Introduction & back ground: Antimicrobial resistance (AMR) develops with the inappropriate use, which includes the wrong indication, mode of use, and the poor adherence of the prescribed drugs. Knowledge is the first step in modifying behaviour in relation to physician’s adherence to antibiotics prescription practice. Methods: We did a cross sectional survey of 737 doctors at three tertiary care teaching hospital to assess their Knowledge, perception and attitude regarding Antimicrobial resistance. Anaesthetists, Pre & para clinical doctors who were general practitioners also participated in the survey. Results: About 93% of doctors strongly agreed /agreed that AMR is a worldwide problem; only 75% rated that it’s a problem in their institution. Nearly 85% doctors believed that inappropriate antibiotics use were important cause of Resistance. Also only 81% agreed that poor infection control measures & poor isolation precautions contribute to AMR. Another survey following a CME showed that educational intervention plays an important role in updating clinicians AMR knowledge.
Antibiogram Analysis and Altering Antimicrobial Susceptibility Pattern of Multidrug Resistant Pathogens
Introduction: In the current situation of escalating antibiotic resistance it is essential to identify and report sensitivity pattern of these MDR bacteria in order to tailor empirical therapy and hygienic measures. Because there will be hardly any new antibiotics in the near future, a better understanding is needed on the how to optimize the use of existing antibiotics, alone and in combination with other drugs. To achieve this, periodic monitoring and surveillance of hospital antibiogram is mandatory. Materials & Methods: Antibiogram surveillance was done for a five year period from Jan-2008 to December 2012 .The report generated was as per CLSI guidelines. A longitudinal analysis of prevalent rates of MDR pathogens-ESBL Enterobactericiae, MRSA, Imipenem resistant Gram negative bacilli isolated from all clinical samples and their sensitivity pattern was done. Results: The most prevalent MDR gram negatives at our centre were ESBL E.coli & ESBL Klebsiella pneumonia (73% & 61% respectively) and MRSA among Gram positives at 24.5%. Pseudomonas was the most predominant Imipenem resistant gram negative bacilli. Uropathogenic E.coli strains had better sensitivity to Nitrofurantoin at 63%. Imipenem showed 90- 100% sensitivity to E.coli & Klebsiella and 70-80 % to Pseudomonas. MRSA was predominantly from soft tissue infection showing 100% sensitivity to Linezolid & 99% to Vancomycin. Conclusion: During the study period a narrow spectrum of sensitivity was observed for commonly used antibiotics. An empirical antimicrobial Guideline was drafted following the Antibiogram Surveillance. Infection control measures & antimicrobial stewardship had proven to be modestly effective in our study.
