PP 5 - Audit on antimicrobial utilization using Days of Therapy as a metric over one month at a pediatric tertiary care hospital in Sri Lankae hospital in Sri Lanka

Fernando KDL, Edirisooriya LS, Lakmali WS, Vidanagama DS , Lady Ridgeway Hospital for Children, Colombo

Abstract

Introduction

Antimicrobial resistance is a global issue. To guide antimicrobial stewardship programmes, it is essential to understand antimicrobial utilisation patterns. Days of Therapy (DOT) is a WHO-recommended metric for the paediatric population due to weight-based dosing. The adult metric, Defined Daily Doses (DDDs), cannot be used.

Objectives

The audit aimed to assess the antimicrobial utilisation patterns of the wards and Intensive Care Units (ICUs) of Lady Ridgeway Hospital for Children, Colombo, in the month of August 2025, using DOT as the metric.

Design, setting, methods

The audit was conducted across 18 units (4 ICUs and 14 wards). One DOT represented the administration of an antimicrobial to a patient on a given day, irrespective of the number of doses or strength. Antimicrobials were categorised according to the AWaRe classification. The in-house data collection tool was completed by the nurse managing the medicine stocks of each unit on a daily basis. DOT per 100 patient days was calculated to compare wards with differing patient densities.

Results

A total of 8733 DOTs were documented. Of these, 58% (n=5059) belonged to the Access group. Watch and Reserve groups accounted for 37% (n=3222) and 5% (n=452), respectively.  This demonstrated proximity to the WHO target of 60% antimicrobial use from the Access group. The proportion of average Access group DOT/100 patient days was greater in wards than in ICUs (63.6% vs. 30.3%). MICU and SICU accounted for the highest Watch antimicrobial use (149 and 85 DOT/100 patient days, respectively). Meropenem use was highest in ICUs (44 and 21 DOT/100 patient days in the MICU and SICU, respectively). Reserve antimicrobial use was highest in MICU (36 DOT/100 patient days). Levofloxacin utilisation was minimal (0.2% DOT, 19/8733) across all units, reflecting adherence to national policies.

Conclusion

This audit demonstrated an antimicrobial utilisation pattern in keeping with WHO antimicrobial stewardship principles. The findings may not be generalisable as the audit was limited to one month. Continued stewardship programmes can be done using this pilot study as a baseline.