Antimicrobial Usage during COVID-19 Pandemic in Intensive Care Unit at a Tertiary Care Hospital in Eastern India: A Retrospective Study

Introduction: Antimicrobials, one of the greatest contributions of the 20th century to the field of therapeutics, appear to be crucial defense in severely ill Coronavirus Disease-2019 (COVID-19) patients. However, a major concern is the excessive and, in a few cases, irrational use of antimicrobials, leading to the global crisis of the emergence of multidrug-resistant microbial strains. Thus, prompt action is needed to optimise antimicrobial therapy. In this context, a situation analysis, such as the present study, focusing on medication management in COVID-19 patients, can help identify key gaps so that appropriate measures may be undertaken to ensure rational antimicrobial therapy in the future.Aim: To analyse the antimicrobial use pattern during the COVID-19 pandemic in the Medical Intensive Care Unit (MICU) of a tertiary care hospital and assess the existing hospital antimicrobial policy.Materials and Methods: A hospital-based, retrospective observational study was conducted in the Department of Pharmacology at a Tertiary Care Hospital (Government Medical College Kolkata), West Bengal, India. The study duration was two months, September and October, 2022. Data were extracted from the standard clinical records of all diagnosed COVID-19 adult patients (>= 18 years) admitted for atleast 24 hours in the MICU between April 2021 and June 2021 {positive result on a Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) assay of a specimen collected with a nasopharyngeal swab indicated a positive diagnosis}. Records containing incomplete data were excluded. A total of 128 records were analysed. Group A included data on patients who expired (n=100), and group B contained data on patients who survived (n=28) during these two months. For the hospital antimicrobial policy, a personal interview was conducted with the Intensive Care Unit (ICU) incharge. Categorical variables were expressed as frequencies (n), percentages (%), and continuous variables were expressed as mean +/- Standard Deviation (SD). Pearson's Chi-square test and Mann-Whitney U test were used to assess the significance level for categorical and continuous variables, respectively. A p-value of <0.05 was considered significant.Results: The mean age of the study participants in group A was 58.31 +/- 15.22 years and in group B was 51.93 +/- 18.33 years. Out of the 128 records collected, 100 patients (78.12%) had succumbed in the ICU during the particular period. Each patient had received an average of 18 drugs and 4.27 Antimicrobial Agents (AMAs) during their stay in the ICU. More than 80% of patients had received concurrent AMAs. Meropenem was the most frequently prescribed AMA (93 patients, 72.65%), followed by piperacillin/tazobactam (88 patients, 68.75%) and doxycycline (79 patients, 61.71%). More than 80% of patients received antimicrobials in the MICU, and an average of 4 AMAs were used per patient. The choice of AMA was empirical. There was no significant relationship between the number and type of AMAs received by the patients and the final clinical outcome. There was no antibiogram or Institutional antimicrobial policy.Conclusion: The study indicates extensive, empirical use of antimicrobials in the MICU, often in combination, without an available antibiogram and without any impact on the clinical outcome of the admitted patients. The findings thus warrant the urgent establishment of a hospital antimicrobial policy to encourage rational antimicrobial therapy in the future.