Antibiotic use in the intensive care unit

On a background of a number of antibiotics in hand and no governing laws for their rational use, we have attempted to get a snapshot of the current trends of use of antibiotics in critically ill patients with infection as a primary cause, in our hospital. This was a prospective observational study carried over a period of 1 year. Critical cases arising from Infection as a primary cause were selected. Demographic data, parameters to mark severity and corresponding list of Empiric, response related and culture driven changed antibiotics were noted. Data of 50 patients, with a mean age of 62.2 years were analyzed. In the 64% community and 34% hospital-acquired infections, Lung was the major source of infection. Mean APACHE score of the group was 18. There were 37 survivals and 13 deaths in the group. There is a trend of using Piperacillin Tazobactum and Third Generation Cephalosporins as Empiric antimicrobials. Fluoroquinolones are also found to be used frequently. The frequency of third generation cephalosporins drops in the response related changes and the dependence on Carbapenems significantly rises. The major finding here is that colistin sensitivity is frequently being indicated in Culture reports. This has resulted in significant increase in its use post culture reports The total cost incurred on antimicrobial agents in the entire group was Rs 14,55,160/-Thus the approximate amount of expenditure on microbials alone to save one life in our Intensive Care Unit was (1455160/37) Rs 39328/-Further study conducted for a longer time with a larger data size needs to be done to perform a multivariate analysis of Severity of Illness, Generation of Antimicrobial as empiric therapy and Outcome A significant variation in the costs of the various brands of the same molecule is noted. A vigilant approach to reduce unnecessary costs while treating critical patients is necessary.