Swapnil Gautam

Abstract

Introduction: Cardiovascular diseases are the most common cause of morbidity and mortality. Prevention of surgical site infection is the major concern in cardiac surgery because deep sternal infection leads to prolonged hospital stay, increased cost of treatment and even death. The cardiac surgeons have used many different therapeutic protocols for antimicrobial prophylaxis. Aims & Objectives: The aim of this study is to evaluate the prescribing pattern of antibiotics in patients undergoing cardiovascular thoracic surgery (CVTS). Material and Methods: A single centre retrospective study was conducted in the CVTS department from January 2017 to October 2018. The hospital has centralised electronic medical and laboratory record database that uses unique identification numbers. The data was obtained from medical record department of the hospital. All records including patient’s age, gender, admission period, investigations performed, antibiotics advised during indoor stay and at discharge along with their administration routes, dosages and duration were noted. The pre-existing comorbidities and surgical intervention were also recorded. Results: Among the total 86 patients reviewed, 88.84% were males with the mean age of 58.7 years. 87.21% of the patients received parenteral antibiotics, 98.83% received more than one antibiotic, either in oral or parenteral formulations. The most commonly used generic antibiotics were cefoperazone – sulbactam (69.77%), levofloxacin (59.30%), cefuroxime (25.58%), cefoperazone (11.63%) and amoxicillin – clavulanic acid (43.02%). While in admitted patients, beta lactam / beta lactamase inhibitors combination (98.83%), fluoroquinolones (69.77%), cephalosporins (34.88%), glycopeptides (3.49%) and carbapenem (2.33%) were used and on the other hand at the time of discharge, fluoroquinolones (43.02%), cephalosporins (32.56%) and beta lactam / beta lactamase inhibitors combination (39.53%) were prescribed. The indications for admission were Coronary artery bypass grafting (90.7%), Aortic valve replacement (5.81%), Mitral valve replacement (2.33%) and Dual valve replacement (1.16%). The most common associated comorbidities were ischemic heart disease (73.26%), diabetes mellitus (47.67%), hypertension (56.98), chronic kidney disease (5.81%) and chronic obstructive pulmonary disease (3.49%). The mean duration of usage of parenteral drugs was 5.20 days whereas it was 5.14 days for the oral drugs. Conclusion: There was an irrational usage of antibiotics in patients undergoing surgery in the CVTS department. The prescription pattern varied according to the surgeon’s preference or experience. This study strongly recommends the implementation of antimicrobial stewardship programme and written protocol driven antibiotics prescription. Keywords: Antibiotics, Antimicrobial stewardship, CVTS, Prescription, Tertiary care hospital

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Abstract

Tubercular Meningitis (TBM) usually presents as a sub-acute to chronic illness, with duration of symptoms ranging from weeks to months before clinical presentation. The course of disease is divided into 3 clinical stages- the stage of prodrome, phase of neurological symptoms and paretic stage, which usually progresses gradually over a period. Here we report an unusual case of TB meningitis in young female, which progressed rapidly over a period of 7-10 days from symptom onset, without any prodromal features or previous evidence of Koch’s, to reach a non-salvageable stage despite all the available diagnostic and therapeutic modalities.   Keywords: Tubercular Meningitis, Dexamethasone, Thalidomide.

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