Background Medical intensive care units (MICUs) provide specialized care for critically ill patients requiring continuous monitoring. High staff density, frequent use of broad-spectrum antibiotics, and invasive procedures increase the risk of infections. Antimicrobial agents (AMAs), including antibacterial, antiviral, antifungal, and antiparasitic drugs, target specific pathogens. This study aimed to evaluate antimicrobial prescribing patterns in patients admitted to the MICU of a tertiary care hospital. Methods This prospective, single-center observational study was conducted over one year, with data collected from October 2023 to March 2024 in the MICU of a tertiary care hospital. A total of 238 MICU patients meeting the inclusion criteria were enrolled after obtaining informed consent. Data were collected from health management information system-generated prescriptions and patient interviews, including diagnosis, medical history, and treatment details. Demographic characteristics, duration of stay in MICU, comorbidities, and prescriptions were recorded and analyzed using descriptive statistics such as percentages, mean ± SD, and IQR. Results Among 238 patients, 55% were male, with a mean age of 38.47 ± 16.69 years. The majority (47.05%) belonged to the 21- to 40-year age group. Among 238 MICU patients, the most common cause of admission was acute febrile illness (13.87%), followed by lower respiratory tract infection (10.50%) and cardiogenic shock (7.98%). In our study, the most common duration of stay was 5 days (19.75%), followed by 3 days (18.49%) and 4 days (17.23%). Median duration of stay was 5 days (IQR: 3-7), with an overall range of 1 to 19 days. Among 1250 prescriptions, the total number of drugs prescribed was 10016, of which 2518 were AMAs. The average AMAs per prescription were 2.02 ± 1.01. The majority (36.40%) had at least two AMAs prescribed. Ceftriaxone (21.72%) and piperacillin-tazobactam (12.11%) were the most prescribed, with 67.71% used empirically and 23.07% for prophylaxis. Among 238 patients, 103 (43.28%) underwent blood culture testing. Of 113 cultures, 62.83% were positive and 37.17% negative. The most common isolates were Streptococcus pneumoniae (18, 25.35%), Escherichia coli (17, 23.94%), and Klebsiella spp. (13, 18.31%). Streptococcus pneumoniae (25.35%) showed the highest resistance to penicillin (88.89%), Escherichia coli (23.94%), and Klebsiella spp. (18.31%) to ceftriaxone (82.35% and 100%), while Acinetobacter spp. showed complete resistance to ceftriaxone. Streptococcus pyogenes showed the highest resistance to azithromycin and ceftriaxone (80% each). Pseudomonas aeruginosa showed multidrug resistance but remained sensitive to amikacin, imipenem, and colistin; MRSA isolates were sensitive to linezolid, tigecycline, and daptomycin. Conclusion The study revealed a tendency towards polypharmacy. Cephalosporins were most prescribed, followed by penicillin-beta-lactamase inhibitor combinations and glycopeptides. Most prescriptions were empirical, with fewer prophylactic and definitive therapies. The resistance pattern suggests overuse of broad-spectrum empirical therapy, limited culture-guided treatment, and possible gaps in infection control. Although some higher antibiotics remain effective, emerging resistance to carbapenems and colistin highlights the need for regular surveillance, rational prescribing, improved diagnostics, and strict antimicrobial stewardship.
Bonde et al. (Mon,) studied this question.