May 01, 2012
Sir Ganga Ram Hospital (SGRH), one of New Delhi’s top medical facilities, is now using a Drug Resistance Index (DRI) to summarize trends in the effectiveness of antibiotics prescribed in the hospital. An index for four common infections treated between 2009 and 2011 is featured in SGRH’s April microbiological newsletter (page 7).
CDDEP developed the DRI to help quantify and communicate overall changes in the effectiveness of our antibiotic arsenal. By combining the ability of antibiotics to kill bacteria with the extent of their importance (measured in terms of quantity used), the DRI provides an aggregate trend measure of drug resistance much like a stock market index summarizes the value of traded companies.
An earlier paper laid out the concept using national (U.S.) data. However, the true power of a DRI lies in applying the tool at the level of the individual facility, where it can directly inform physicians about the constantly evolving landscape of resistance. There are tens, if not hundreds, of bacteria-antibiotic combinations, resistance patterns are constantly changing, and some antibiotics are more important to preserve than others, making it difficult for a non-expert to track the evolution of the problem. By painting a simple picture of resistance at the facility level, a DRI can help tailor antibiotic purchasing and prescribing policies to an individual hospital s resistance profile, and inform hospital administrators about whether interventions to curb the spread of resistant infections are making a difference.
What does it take to implement a DRI? Dr. Chand Wattal, chairman of SGRH s microbiology department, reflected that SGRH piloted the index without considerable effort. In most cases, it can be done using existing data. Hospitals can use antibiogram and antibiotic use data routinely collected as part of patient care information a lot of facilities can provide from administrative databases and free laboratory software such as WhoNet. The rest is a simple spreadsheet calculation.
The figure below shows the results from SGRH and reveals alarming levels of resistance among Gram-negative bacteria challenging and widespread in India. The scale ranges from 0 to 1, where 1 means all infections were untreatable with available antibiotics. At SGRH, the 2011 DRI value was 0.54 for E. coli and 0.8 Acinetobacter baumannii. These levels are high in comparison to aggregate U.S. figures, where the DRI levels for the same species were 0.27 and 0.48 (comparisons come with several caveats the U.S. index is for 2006, includes outpatients, and draws older data from over 300 hospitals). On a more positive note, the DRI also shows resistance levels decreasing in the last two years, along with antibiotic usage, which, the newsletter suggests, reflects the success of antimicrobial stewardship efforts at SGRH.
SGRH is at the forefront of institutions to make use of the DRI concept, demonstrating how existing data can be used to produce intuitive and revealing summaries of antibiotic resistance. Facilities from around the world have expressed interest in implementing a DRI, and CDDEP has developed tools and guidelines to assist these early adopters. If you would like your facility to be among the first to try a DRI, please contact me at [email protected]
Image credit: Flickr: DeniseGiles
