ANTIMICROBIAL AGENT’S UTILIZATION AND COST PATTERN IN MEDICAL INTENSIVE CARE UNIT OF A TERTIARY CARE HOSPITAL

Sartaj Hussain,Suraj Singh Yadav,Sanjay Khattri,Kamal Kumar Sawlani,Kauser Usman

doi:10.22159/ijpps.2021v13i8.41338

Abstract

Objective: The objective of this study was to evaluate the utilization and cost pattern of AMAs (Antimicrobial Agents) in the Medical ICU of a tertiary care teaching hospital, and to determine the predictor of antimicrobial number per day. Methods: A prospective cross-sectional study was carried out and a total of 101 patients were studied. The drugs were classified into different groups according to the World Health Organization’s ATC (Anatomical Therapeutic Chemical) Classification System. Results: The mean [95% confidence interval (CI)] duration of ICU stay was 7.11 (5.70-8.52) days and the mortality rate in the ICU was 42.6%. The AMAs DDD (Defined Daily Dose) per 100 patient days and number of AMAs per prescription were 296.64 and 2.65, respectively. Piperacillin-tazobactam was the most commonly utilized AMAs followed by metronidazole, meropenem, fluconazole, and colistin. The mean number [95% CI] of AMAs, DDD, and cost (INR) per patient were 18.82 (14.05-23.59), 21.09 (15.36-26.81) and 25,827 (18,716-32,939) respectively. The AMAs constituted 88.53% of the total treatment cost. Meropenem was the most costly AMA (32.10% of the total AMAs cost) followed by imipenem-cilastatin (20.50%), colistin (14.65%), piperacillin-tazobactam (8.40%), and clindamycin (4.47%). The independent predictor for the antimicrobial number per day was acute physiology and chronic health evaluation II (APACHE-II) score at admission and nosocomial infections. Conclusion: The AMAs, DDD per 100 patient days, and number per prescription were higher. This leads to a higher cost of AMAs per patient and the AMAs cost out of the total cost as compared to previous studies. We suggest, there is a need to formulate and implement an antimicrobial restriction policy.

Highlights

World Health Organization (WHO) has defined drug utilization research as “the marketing, distribution, prescription, and use of drugs in society, with special emphasis on the resulting medical, social, and economic consequences” [1].The patients admitted to the medical intensive care units (ICUs) are generally seriously ill or require specialized care and close monitoring
The higher utilization and inappropriate use of antimicrobial agents (AMAs) lead to the development of antimicrobial resistance (AMR) in the ICUs [4, 5]
The cost of AMAs per patient and the AMAs cost out of the total cost was quite higher in comparison to the previous studies

Summary

Introduction

The patients admitted to the medical intensive care units (ICUs) are generally seriously ill or require specialized care and close monitoring. They are predisposed to get infected either due to various invasive procedures or secondary to nosocomial infection. The antimicrobial agents (AMAs) utilization rate is high in ICUs as compare to the general wards [2]. Multiple broad-spectrum AMAs are usually administered empirically to these patients and this usually leads to the inappropriate use of AMAs [3,4,5]. The higher utilization and inappropriate use of AMAs lead to the development of antimicrobial resistance (AMR) in the ICUs [4, 5]. The AMR is the major determinant of therapeutic outcomes [6]

Methods

Results

Discussion

Conclusion