Pharmacoepidemiological analysis of antimicrobial therapy for burn injury in the hospital settings

Abstract

Aim : to conduct a pharmacoepidemiological analysis of antimicrobial therapy of burn injury in the hospital settings. Materials and methods . The study was based on medical records of patients with burn injuries hospitalized in the Volga University Hospital (Nizhny Novgorod) in 2018. DDD (Defined Daily Dose) analysis was used to evaluate the actual drug consumption based on the defined daily dose; DU90% (Drug Utilization 90%) analysis allowed us to assess the consumption of drugs based on their representation in the total number of defined daily doses; the “cost of illness” and ABC analyses were also used. Results and discussion . For antimicrobial agents of interest, the NDDD (Number of DDD) per year, and the NDDD/100 bed-days were determined. Among these antimicrobial agents (AMA), the largest number of prescriptions was noted for vancomycin (18.06% of treatment courses and 92.86% of patients); amikacin (15.28% of treatments and 78.57% of patients); tigecycline (13.89% and 71.43%, respectively); cefoperazone / sulbactam (12.50% and 64.29%) and co-trimoxazole (12.50% and 64.29%). The NDDD/100 bed-days value for vancomycin was 100.73, followed by amikacin and co-trimoxazole: 86.85 and 71.93 NDDD/100 bed days, respectively. Other antimicrobial agents had significantly lower consumption rates. A group containing 90% of NDDD of antimicrobial agents used for burn injury included: vancomycin – 22.30% of total consumption; а mikacin – 19.23%; co-trimoxazole – 15.93%; cefoperazone / sulbactam – 10.72%; tigecycline – 10.54%; cefepime – 6.47%; levofloxacin – 3.04%. These agents accounted for 83.33% of all drug dose prescriptions. The costs of one DDD in segments DU10% and DU90% amounted to 1976.80 rubles and 1282.58 rubles, respectively. In group A, 80% of costs were for tigecycline – 41.98%; vancomycin – 19.06%; cefoperazone / sulbactam – 6.98%; cefepime – 6.82%. The average costs of treatments with AMA from group A were 15112.45 rubles, from group B – 24082.86 rubles, and from group C – 3498.58 rubles. Implications . The AMAs most commonly used in the treatment of burn injury are vancomycin, amikacin, tigecycline, cefoperazone / sulbactam and co-trimoxazole. The use of vancomycin, tigecycline, cefoperazone / sulbactam and co-trimoxazole is associated with the highest costs of AMA therapy. In the overall spending structure, the cost of amikacin therapy represents an insignificant part (i.e., group C according to the ABC analysis). Notably, amikacin is prescribed more often than other drugs because of its high efficacy in the hospital settings and its low price. We found that more expensive AMA (ertapenem, polymyxin B, linezolid, piperacillin / tazobactam) were used when the starting regimen of antimicrobial therapy produced no adequate clinical effect. Conclusion . This pharmacoepidemiological analysis made it possible to take a broader look at the cost of AMA consumed by the patients and not only those purchased by the hospital. The results provide for a rational approach to the selection of AMA names and doses.