The organisms isolated in our hospital BLDE (DU) Shri B M Patil Medical College Hospital & Research Centre Vijaypur Karnataka India were Pseudomonas aeruginosa (192), Klebsiella pneumonia (173), Escherichia coli (168), Citrobacter species (117), Acinetobacter species (47), and Proteus species (39) (Table No 1).

Our study which aims at formulating an empirical therapy for Gram negative organisms the drugs with highest sensitivity were Imipenem (51%), Amikacin (43%), Meropenem (38%), Tobramycin (36%), and Ciprofloxacin (34%) Gentamicin (34%), Netimicin (33%), Cotrimoxazole (32%), Piperacillin (28%), Tetracycline (28%), Ceftazidime (28%), Levofloxacin (26%), Ceftriaxone (26%), Colistin (22%), Carbenecillin (21%), Cefoperazone(21%), Cefoperazone + Sulbactum (21%), Azonetrem (21%), Cefipime (20%), Cefuroxime (17%), Cephaxlein(15%), Ampicillin (12%), Amoxyclav (10%) (Table No 3)

Gram negative organisms recovered from Skin & Soft tissue infections among patients were more susceptible to Carbapenems (Imipenem, Meropenem), Aminoglycosides (Amikacin, Tobramycin, Gentamicin) followed by Ciprofloacin and Cotrimoxazole, Piperacillin, 3rd generation Cephalosporins (Ceftazidime, Ceftriaxone, Cefotaxime); Colistin, Carbenecillin 4^th Generation Cephalosporins (Cefepime), β lactam/ β-lactamase inhibitor combinations (Cefoperazone-Sulbactaum).

After discussing with the clinicians mainly surgeons a list of first line of drugs was drawn Aminoglycosides (Amikacin, Gentamicin, Tobramicin and Netimicin) which are injectables were given the first priority followed by the 3^rd generation Cephalosporins (Ceftazidime, Ceftriaxone, Cefotaxime) then by the 4th generation Cephalosporins (Cefepime) which are available orally also then by b-lactam/ β-lactamase inhibitor combinations (Cefoperazone-Sulbactam) then by the Colistin and keeping the Carbapenems (Imipenem and Meropenem) as reserved drugs both in terms of efficiency and cost though they have highest sensitivity. So list of drugs used as Empirical therapy in the treatment of Gram negative infections is as follows:

Hospital antibiogram can be a guiding tool for empirical therapy and can also track the emergence of resistance among the bacterial isolates in the nosocomial environment. There can be a wide variation in the manner in which the antibiograms are formulated and reported which results in intra and inter hospital comparisons⁸.

Though the treatment may be dependent on the culture, empirical therapy is  necessary and should be designed so that it can cover the both Gram positive and Gram negative organisms till the culture report is available. Surveillance of the antibiotic sensitivity should be done on regular basis as the pathogens and their sensitivity keep on changing and also vary from unit to unit, hospital to hospital^9,10.

It is very much essential that all the clinicians should understand the importance of antibiotic susceptibility testing. Always there has to be mutual sharing of expertise, cooperation and collaboration between the clinicians and microbiologist so that there can be optimum and appropriate use of antibiotics in the management of infectious diseases. Though many studies of regional antibiogram have been reported from India, there is a need for nationwide statics to be generated and made available to the clinicians¹¹.  An ICMR guideline 2019 for the use of antimicrobials is already available for guiding the empirical therapy but the local antibiogram of the hospital will give exact sensitivity pattern which can have a day to day application.

But again it is the treating physician/surgeons decision to choose the class of antibiotic as the antibiotic policy has many limitations and also the patient factor needs to be considered including the type and severity of infection, the infecting organism, past antibiotic history.

Bacterial antimicrobial resistance is a great challenge to the medical community and also to the patients in terms of increase in morbidity, mortality and economic burden. Political involvementie the health ministry has to come forward with strict implementation of national antibiotic policies with the cooperation of private corporate setups.

Clinician should not be pressurized to write an antibiotic on patient’s demand of early recovery; this will be possible only when the patient is aware of the judicious use of antibiotics which can be achieved through public education or campaigns just like other national health education programs¹².

It is quite essential to define an antimicrobial stewardship program as an ongoing effort by an health care institution to optimize the antimicrobial use among hospitalized patients to improve patient outcomes, ensure cost effective therapy and reduce adverse squeal of antimicrobial use¹¹.