A Nationwide Pharmacoepidemiological Analysis of the Impact of Health Policy on Antimicrobial Use in Critical Care Settings in India

A nationwide multicentric pharmacoepidemiologic analysis of antimicrobial use in critical care settings over a 2 year period in India, revealed that 76.0% (22,920) received at least one antimicrobial with 36.6% (11,027) receiving multiple antimicrobials. When classified based on the WHO AWaRe stratification, Watch group antimicrobials were most frequently ordered (56.7%;17103 patients), with the joinpoint regression analysis indicating its peak use during the second COVID-19 wave (May 2021-December 2021: MPC=2.01, p<0.05) and significantly higher odds noted in patients with COVID-19 (aOR:6.73 (5.78-7.88)), APACHE-II >10 (aOR:1.60 (1.49-1.71)) and ventilation requirement (aOR:1.68 (1.55-1.83)), thus indicating their use as empiric antibiotic therapy particularly in severely ill COVID patients. Individual COVID-specific Antimicrobials (CSA) exhibited temporal and geographical variation congruent with the release of scientific literature and local treatment guidelines, reflecting proactive implementation of treatment protocols. Antimicrobials are used extensively in ICUs across India, but overall and individual trends were largely influenced by scientific literature and public health messaging.