Utilisation of antimicrobial agents in intensive care unit at a tertiary care teaching hospital in eastern India

Rajendra Kumar Panda; P. Ansuman Abhisek; Lalit Mohan Sika; Shweta Supriya Pradhan; Sidharth Srabana Routray; Srikanta Mohanty

doi:10.18203/2319-2003.ijbcp20193672

Authors

Rajendra Kumar Panda Department of Pharmacology, S.C.B. Medical College, Cuttack, Odisha, India
P. Ansuman Abhisek Department of Pharmacology, MKCGMCH, Berhampur, Odisha, India
Lalit Mohan Sika Department of Pharmacology, DHH, Khurda Odisha, India
Shweta Supriya Pradhan Department of Pharmacology, MKCGMCH, Berhampur, Odisha, India
Sidharth Srabana Routray Department of Anaesthesiology and Crictical Care, SCBMCH, Cuttack, Odisha, India
Srikanta Mohanty Department of Pharmacology, Hi-Tech Medical College, Bhubaneswar, Odisha, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20193672

Keywords:

Intensive care unit, Utilisation pattern, Antimicrobial agents, Anatomic therapeutic chemical classification, DDD per 100 bed days, APACHE II score

Abstract

Background: Antimicrobial agents (AMAs) are the most frequently used drugs in the intensive care units (ICU) and regular auditing can prevent the development of resistance to AMAs, reduce the cost and incidence of adverse drug reactions. The present study was conducted to assess the drug utilisation pattern by measuring the defined daily dose (DDD) per 100 bed days for the AMAs used and their correlation with the APACHE score II.

Methods: This was a prospective observational study, conducted in the Central ICU of SCB Medical College and Hospital, Cuttack, Odisha for 4 months. Data regarding demographic profile, diagnosis, APACHE II score, microbiologic investigation, length of stay, outcome and utilisation pattern of AMAs assessing anatomic therapeutic chemical (ATC) classification and measuring the antimicrobial consumption index (ACI) equal to DDD per 100 bed days were collected and subjected to descriptive analysis. Multinomial logistic regression model was used to predict probabilities of different possible outcomes of categorically distributed variables and independent variables.

Results: Mean age of study population was 44.70±14.814 with male and female ratio of 1.63:1. Septicaemia was the most common cause of admission. AMAs were prescribed to 92.66% of patients during their stay which constitutes 37.32% of the total drugs used. The DDD per 100 bed days for the AMAs were 118.59 and ceftriaxone was found to be most frequently used. Patients having higher APACHE II score received more no of AMAs (4.20±1.30). Patients having low APACHE II Scores received less number of antibiotics as compared to patients having higher score.

Conclusions: AMAs were prescribed to 92.66% patients in the central ICU and there is significant relation between the APACHE II score and number of AMAs prescribed.

Metrics

Metrics Loading ...

References

Williams A, Mathai AS, Phillips AS. Antibiotic prescription patterns at admission into a tertiary level intensive care unit in Northern India. J Pharm Bioall Sci. 2011;3:531-6.

WHO Expert Committee on the Selection of Essential Drugs, 17-21 October 1977 - WHO Technical Report Series, No. 615 (1st WHO Model List of Essential Medicines) Internet. Apps.who.int. Available at: http://apps.who.int/medicinedocs/en/ m/abstract/Js20185en/. Accessed on 27 March 2019.

Sachdeva PD, Patel BG. Drug utilization studies – Scope and future perspectives. Int J Pharm Biol Res. 2010;1:11-7.

Krivoy N, El-Ahal WA, Bar-Lavie Y, Haddad S. Antibiotic prescription and cost patterns in a general intensive care unit. Pharm Pract (Granada). 2007;5:67-73.

Røder BL, Nielsen SL, Magnussen P, Engquist A, Frimodt-Moller N. Antibiotic usage in an intensive care unit in a Danish University Hospital. J Antimicrob Chemother. 1993;32:633-42.

Marschner JP, Thürmann P, Harder S, Rietbrock N. Drug utilization review on a surgical intensive care unit. Int J Clin Pharmacol Ther. 1994;32:447-51.

Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE-acute physiology and chronic health evaluation:a physiologically based classification system. Crit Care Med. 1981;9(8):591-7.

APACHE II Scoring System Internet. reference. medscape.com. Available at: https://reference. medscape.com/calculator/apache-II-scoring-system Accessed on 27 March 2019.

Internet. WHOcc.no. Available at: https://www.whocc.no/filearchive/publications/ 1_2013guidelines.pdf. Accessed on 27 March 2019.

Surveillance of Antimicrobial Use Internet. World Health Organization. 2019. Available at: https://www.who.int/medicines/areas/rational_use/AMU_Surveillance/en/. Accessed on 27 May 2019.

Vandana AB. Study of Prescribing Pattern of Antimicrobial Agents in Medicine Intensive Care Unit of a Teaching Hospital in Central India. J Assoc Physicians India. 2012;60:20-3.

Anand N, Nayak N, Advaitha MV, Thaikattil NJ, Kantanavar KA, Anand S. Antimicrobial agents' utilization and cost pattern in an Intensive Care Unit of a Teaching Hospital in South India. Indian J Crit Care Med. 2016;20:274-93.

Patel MK, Barvaliya MJ, Patel TK, Tripathi C. Drug utilization pattern in critical care unit in a tertiary care teaching hospital in India. Int J Crit Illn Inj Sci. 2013;3(4):250-5.

Shankar PR, Partha P, Dubey AK, Mishra P, Deshpande VY. Intensive care unit drug utilization in a teaching hospital in Nepal. Kathmandu Univ Med J (KUMJ). 2005;3(2):130-7.

Patanaik SK, Pattanayak C, Prasad A, Chauhan AS. Drug utilization pattern in an intensive care unit setting in Eastern India. Int J Basic Clin Pharmacol. 2015;4:1136-41.

Hedamba R, Doshi C, Darji NH, Patel B, Kumari V, Trivedi HR. Drug utilization pattern of antimicrobial drugs in intensive care unit of a tertiary care hospital attached with a medical college. Int J Basic Clin Pharmacol. 2016;5:169-72.

Amit GS. Drug use evaluation study in a tertiary care corporate hospital with special reference to use of antibiotics in ICU department. Int J Adv Pharm Biol Chem. 2013;2:179-89.

Pandiamunian J, Somasundaram G. A study of prescribing pattern of Antimicrobial agents in the medical intensive care unit of a tertiary care teaching hospital in Puducherry union territory south India. Int J Pharm Pharm Sci. 2014;6(3):235-8.

Biswal S, Mishra P, Malhotra S, Puri GD, Pandhi P. Drug utilization pattern in the intensive care unit of a tertiary care hospital. J Clin Pharmacol. 2006;46:945-51.

Hanssens Y, Ismaeil BB, Kamha AA, Elshafie SS, Adheir FS, Saleh TM. Antibiotic prescribing pattern in a medical intensive care unit in Qatar. Saudi Med J. 2005;26:1269-76.

Usluer G, Ozgunes I, Leblebicioglu H. Turkish Antibiotic Utilization Study Group. A multicenter point-prevalence study: Antimicrobial prescription frequencies in hospitalized patients in Turkey. Ann Clin Microbiol Antimicrob. 2005;4:16.

Meyer E, Jonas D, Schwab F, Rueden H, Gastmeier P, Daschner FD. Design of a surveillance system of antibiotic use and bacterial resistance in German intensive care units (SARI). Infection. 2003;31:208-15.

De Castro MS, Pilger D, Ferreira MB, Kopittke L. Trends in antimicrobial utilization in a University Hospital, 1990-1996. Rev Saude Publica. 2002;36:553-8.

Peto Z, Benko R, Matuz M, Csullog E, Molnar A, Hajdu E. Results of a local antibiotic management program on antibiotic use in a tertiary intensive care unit in Hungary. Infection. 2008;36:560-4.

Patil PH, Kuchake VG, Ajay K, Pitambar D, Surana S. Evaluation of drug utilization especially antimicrobial agent pattern in tertiary care unit hospital. Int J Community Pharm. 2009;2:13-23.

John LJ, Devi P, John J, Guido S. Drug utilization study of antimicrobial agents in medical intensive care unit of a tertiary care hospital. Asian J Pharm Clin Res. 2011;4:81-4.

Hartmann B, Junger A, Brammen D, Röhrig R, Klasen J, Quinzio L, et al. Review of antibiotic drug use in a surgical ICU:management with a patient data management system for additional outcome analysis in patients staying more than 24 hours. Clin Ther. 2004;26:915-24.

Meyer E, Jonas D, Schwab F, Rueden H, Gastmeier P, Daschner FD. Design of a surveillance system of antibiotic use and Bacterial resistance in German intensive care units (SARI). Infection. 2003;31:208-15.