Study of Antimicrobial Utilization and Cost of Therapy in Medicine Intensive Care Unit of a Tertiary Care Hospital in Eastern India

Abstract

A bstract Introduction High utilization of antimicrobial agent (AMA) and inappropriate usage in an intensive care unit (ICU) intensifies resistant organism, morbidity, mortality, and treatment cost. Prescription audit and active feedback are a proven method to check the irrational prescription. To analyze and compare the utilization of drugs, the World Health Organization (WHO) proposed daily defined dose (DDD)/100 patient days and days of therapy (DOT)/100 patient days to measure utilization of AMAs. Data of AMAs utilization are required for planning an antibiotic policy and for follow-up of intervention strategies. Materials and methods A prospective observational study was conducted for 1 year from July 2018 to June 2019 and the data obtained from ICU of a tertiary care hospital. The demographic data, the disease data, and the utilization of different classes of AMAs [WHO–Anatomical Therapeutic Chemical (ATC) classification] as well as their cost were recorded. Total number of patient days, DDD, DDD/100 patient days, and DOT/100 patient days were calculated as proposed by the WHO. Statistical analysis was performed using statistical software SPSS version 25.0. The descriptive analysis was performed using summary statistics median [interquartile range (IQR)]. Results A total 939 patients were included, out of them 332 (35.4%) were female. The median age of the total patients was 58 (45–70). The median length of stay in ICU was 3 days. Mortality rate during our study period was 38.6%. The highly utilized AMAs in our study was ceftriaxone (36.95 DDD/100 patient days) followed by piperacillin/tazobactam (31.57), meropenem (26.4), doxycycline (21.53), and polymyxin B (21.38). The association between APACHE II and SOFA score with use of restricted antibiotics found to be statistical significant ( p value 0.018 and 0.000, respectively). The cost of antibiotics per patient and patient days were $449.97 and $93.77, respectively, while median value of total cost was $2,343.26. Conclusion Ceftriaxone was the highest utilized AMA. The risk of receiving restricted antibiotics intensified with increasing prevalence of multidrug resistance bacteria and associated comorbidities. High treatment cost is responsible for higher utilization of restricted antibiotics in ICU. How to cite this article Patra SK, Mishra SB, Rath A, Samal S, Iqbal SN. Study of Antimicrobial Utilization and Cost of Therapy in Medicine Intensive Care Unit of a Tertiary Care Hospital in Eastern India. Indian J Crit Care Med 2020;24(10):938–942.

Quantitative and Qualitative Analysis of Antibiotics in the Intensive Care Unit (ICU)

“…When compared to other studies from the same country, total antibiotic use in this current study was extremely high; the DDD value was 210.1/100 bed-days and 201.6/100 beddays [11], [12]. Antibiotics use, which also demonstrates a high rate of antibiotic consumption in the ICU, was investigated in the ICU of Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.…”

“…The most frequently used type of penicillin was determined to be a combination of piperacillin (4 x 4.5g, IV) and a beta-lactamase inhibitor (tazobactam) according to 12 research articles. The total use of piperacillin-tazobactam was 164,816 DDD/100 bed-days, with the highest consumption recorded in the critical care unit of a tertiary hospital in Bhubaneswar, Odisha, India, at 31.57 DDD/100 bed-days [11]. Piperacillin was frequentlyol used in combination with tazobactam, a beta-lactamase inhibitor.…”

“…Figure1Total Antibiotic Consumption in ICU in DDD/100 Bed-days[23],[18], [28], [29], [30], [31],[13],[9],[8],[11], [34], [35], [36], [16], [37], [38], [40].…”

Drug Utilization Review of Monitored Parenteral Antimicrobials in a Tertiary Care Private Hospital in Cebu City

“…The total cost of antibiotics for an entire year in an ICU department of an Indian hospital was ₱8,502,245.02. This was based on the cost of therapy per patient which was ₱23,293.82 51 .…”

Analysis of Package Inserts of Antimicrobial Drugs Utilised in a Tertiary Care Hospital of North Karnataka

“…Antimicrobial agents form the most common group of drugs used in clinical practice, especially in ICUs [10]. Proper usage of these antimicrobial agents is of utmost importance in clinical practice [11].…”