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Antimicrobial agents' utilization and cost pattern in an Intensive Care Unit of a Teaching Hospital in South India
Nikhilesh Anand1, I M Nagendra Nayak1, M V Advaitha1
1Department of Pharmacology, K S Hegde Medical Academy, Mangalore, Karnataka, India.
Background And Aims:
High utilization and inappropriate usage of antimicrobial agents (AMAs) in an Intensive Care Unit (ICU) increases resistant organisms, morbidity, mortality, and treatment cost. Prescription audit and active feedback are a proven method to check the irrational prescription. Measuring drug utilization in DDD/100 bed-days is proposed by the WHO to analyze and compare the utilization of drugs. Data of AMAs utilization are required for planning an antibiotic policy and for follow-up of intervention strategies. Hence, in this study, we proposed to evaluate the utilization pattern and cost analysis of AMA used in the ICU.
Methodology:
A prospective observational study was conducted for 1 year from January 1, 2014, to December 31, 2014, and the data were obtained from the ICU of a tertiary care hospital. The demographic data, disease data, relevant investigation, the utilization of different classes of AMAs (WHO-ATC classification) as well as individual drugs and their costs were recorded.
Results:
One thousand eight hundred and sixty-two prescriptions of AMAs were recorded during the study period with an average of 1.73 ± 0.04 prescriptions/patient. About 80.4% patients were prescribed AMAs during admission. Ceftriaxone (22.77%) was the most commonly prescribed AMA followed by piperacillin/tazobactam (15.79%), metronidazole (12%), amoxicillin/clavulanic acid (6.44%), and azithromycin (4.34%). Ceftriaxone, piperacillin/tazobactam, metronidazole, and linezolid were the five maximally utilized AMAs with 38.52, 19.22, 14.34, 8.76, and 8.16 DDD/100 bed-days respectively. An average cost of AMAs used per patient was 2213 Indian rupees (INR).
Conclusion:
A high utilization of AMAs and a high cost of treatment were noticed which was comparable to other published data, though an increased use of newer AMAs such as linezolid, clindamycin, meropenem, colistin was noticed.
Insights
High antimicrobial agent use in the ICU leads to resistance and increased costs. This study analyzed antimicrobial drug utilization and costs in an ICU, finding high usage and expenses, with newer agents increasingly prescribed.
Area of Science:
- Infectious Diseases
- Pharmacology
- Critical Care Medicine
Background:
- High antimicrobial agent (AMA) utilization and inappropriate use in Intensive Care Units (ICUs) contribute to antimicrobial resistance, increased morbidity, mortality, and healthcare costs.
- Prescription audits and feedback are effective strategies to curb irrational prescribing.
- Understanding AMA utilization patterns is crucial for developing antibiotic policies and evaluating interventions.
Purpose of the Study:
- To evaluate the utilization patterns of antimicrobial agents (AMAs) in an Intensive Care Unit (ICU).
- To conduct a cost analysis of AMAs used within the ICU setting.
- To provide data for informing antibiotic policies and intervention strategies.
Main Methods:
- A prospective observational study was conducted over one year (January 1, 2014, to December 31, 2014).
- Data were collected from the ICU of a tertiary care hospital, including demographic and disease information.
- Utilization of AMAs, categorized by WHO-ATC classification, and associated costs were recorded.
Main Results:
- 1,862 AMA prescriptions were recorded, with 80.4% of patients receiving AMAs during admission.
- Ceftriaxone was the most frequently prescribed AMA (22.77%), followed by piperacillin/tazobactam (15.79%) and metronidazole (12%).
- The top five utilized AMAs, measured in DDD/100 bed-days, were ceftriaxone (38.52), piperacillin/tazobactam (19.22), metronidazole (14.34), linezolid (8.76), and azithromycin (8.16). The average cost per patient was 2213 INR.
Conclusions:
- The study identified high utilization and significant costs associated with AMAs in the ICU.
- Comparable utilization and cost patterns were observed compared to existing literature.
- An increasing trend in the use of newer AMAs, including linezolid, clindamycin, meropenem, and colistin, was noted.
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