Development of an electronic case record form(AU-Crit) for antimicrobial stewardship program initiation

John Preshanth Kumar Pathiraj 1, Manjunatha H Hande 2, Murulidhar Varma 2, Chiranjoy Mukhyopadhay 3, Roshan David Jathanna 4, Menino Osbert Cotta (Os) 5, Abdul Ghaffur 6


Dept. of Pharmacy Practice, Manipal College Of Pharmaceutical Sciences, Manipal Univerisity, Manipal, Udupi, Karnataka, India

Dept. of Medicine Kasturba Medical College Manipal Univerisity, Manipal, Udupi, Karnataka, India

Dept. of Microbiology Kasturba Medical College Manipal Univerisity, Manipal, Udupi, Karnataka, India

Dept. of Computer Science & Engineering Manipal Institute of Technology Manipal Univerisity, Manipal, Udupi, Karnataka, India

Department of Intensive Care Medicine, Ned Hanlon Building, Royal Brisbane and Women’s Hospital, Herston, Qld, Australia

Apollo Specialty Hospital, Padma Complex, Anna Salai, Chennai, Tamil Nadu, India


Antimicrobial stewardship program is an effective approach widely acknowledged comprising multiple strategies is advocated to overcome adverse outcomes of antimicrobial resistance.
The objective of the study was to develop a clinical decision support system(CDSS) to record antimicrobial utilization in the ICUs.

This is a single centre “before-after” interventional study in a Medicine ICU patients at Kasturba Hospital, Manipal, Karnataka, India approved by the IEC

Development of eCRF (AU-Crit):Was written using C#. As a pilot, 50 patient’s study variables as per inclusion criteria were recorded in the eCRF with Xcel database and analysed. Male predominance with 68%, the median age were 61 (IQR 53-70) were observed. Microbiology isolates (%) from blood, ET-aspirate and Urine for ESKAPE organisms. The pre-dominant culture-positive results were Klebisiella and Enterobacter (10% each), Acenetobacter(14%) and Enterobacter(10%) while 27%, 20% and 12% of them tested culture negative respectively.
Mean Charlston Co-morbidity index and serum protein were 2.6(0.96±SD) and 3.1(0.7±SD) respectively.
Diagnoses were BSI-45%,HAP-35%, Urosepsis-10%,CAP-5% and Aspiration Pneumonia-5%. Kunin’s Appropriateness criteria was highest for Cat II and Cat V with 27% each, 30% got definitive therapy and de-escalation in 72%. Mean LOS was 8 (IQR 4-15), APACHE II-38, SOFA-14 and TISS-28 score-20.
Mean DOT/ 1000 patient days for restricted antimicrobials were Colistin-34.5,Meropenam-16,Vancomycin-10,Teicoplanin-16,Pip-Tazo-98, Cefoperozone+Sulbactum-68 with a mean Direct ICU cost /patient (US$) was-Ventilated:620 and Non-Ventilated:340.

Data collection for the PreCDSS implementation period using AU-Crit is currently underway and the CDSS is on developmental stage with SQLite database for data storage and security.

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