Drug Utilization Evaluation of Antibiotics in Intensive Care Units of a Referral Teaching Hospital
Background: Drug Utilization Evaluation (DUE) studies are designed to assess drug usage appropriateness. This study aimed to evaluate the drug utilization of antibiotics in the intensive care units (ICUs) of a referral teaching hospital.Methods: Patients hospitalized in ICU who received antibiotics were enrolled in this cross-sectional study. Patients’ medical charts were reviewed and data including indication of antibiotics, dosing, dose adjustment, and culture sensitivity test were recorded in a predesigned data collection form. Related guidelines and references were used for judgement about the correctness of these parameters.Results: Among 182 evaluated antibiotic prescriptions, 75.8% of the cases were prescribed empirically that for 31.88% of them, microbial culture and sensitivity test were requested. Indication was appropriate in 51.6%. Fifteen patients needed antibiotic dose adjustment that was performed just for 4 patients. Doses of antibiotics were correct in 58.5% of cases. Meropenem (15.9%), Metronidazole (15.9%), and vancomycin (11.5%) were the most frequently prescribed antibiotics.Conclusion: Use of antibiotics in ICUs of our hospital is associated with high rate of errors especially in the aspects of medical indication and dosage.
2. Fallik B. The Academy of Managed Care Pharmacy's concepts in managed care pharmacy: prior authorization and the formulary exception process. J Manag Care Pharm 2005;11(4):358-61.
3. Bergmans DC, Bonten MJ, Gaillard CA, et al. Indications for antibiotic use in ICU patients: a one-year prospective surveillance. J Antimicrob Chemother 1997;39(4):527-35.
4. Shoaei SD, Bagherzadeh A, Haghighi M, Shabani M. Vancomycin and five broad-spectrum antibiotic utilization evaluation in an educational medical center in one year. Journal of Pharmaceutical Care 2014;2(4):154-61
5. Soltani R, Khorvash F, Pazandeh F. Antimicrobial resistance pattern of nosocomial infections at a referral teaching hospital. Journal of Pharmaceutical Care 2020;8(1):26-34.
6. Singh N, Victor LY. Singh N, Yu VL. Rational empiric antibiotic prescription in the ICU. Chest 2000;117(5):1496-9.
7. Hatcher JC, Dhillon R, Azadian B. Antibiotic resistance mechanisms in the intensive care unit. J Intensive Care Soc 2012;13( 4):297-303.
8. Bisht R, Katiyar A, Singh R, Mittal P. Antibiotic resistance – A global issue of concern. Asian J Pharm Clin Res 2009; 2(2): 34-9.
9. Hashemi S, Nasrollah A, Rajabi M. Irrational antibiotic prescribing: a local issue or global concern? EXCLI J 2013;12:384-95.
10. Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016;63(5):e61-e111.
11. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013;70(3):195–283.
12. American Pharmacists Association (APhA). Drug Information Handbook: A Clinically Relevant Resource for All Healthcare Professionals. 26th ed. Ohio: Lexi-Comp; 2017-2018.
13. Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015.
14. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, editors. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York: McGraw-Hill Medical; 2017.
15. Gilbert DN, Chambers HF, Eliopoulos GM, Saag MS, Pavia AT, Black D, Freedman DO, Kim K, Schwartz BS, editors. The Sanford guide to antimicrobial therapy. Antimicrobial Therapy, Inc.; 2020.
16. Zarezadeh M, Shaterzadeh F, Abedini S, Raadabadi M. Evaluating pattern of prescribing antibiotics in surgical wards of shahid rahnemon hospital compared to standard methods in 2015. Journal of Shahid Sadoughi University of Medical Sciences 2015;23(7):679-690.
17. Mahini S, Hayatshahi A, Torkamandi T, Gholami K, Javadi MR. Carbapenem utilization in critically Ill patients. Journal of Pharmaceutical Care 2013;1(4):141-144.
18. Rafati M.R, Sahraee S, Zamani Z, Irvash M. Antibiotics Usage in Intensive Care Unit in Sari Bouali Sina Hospital. Journal of Mazandaran University of Medical Sciences 2015; 24(122):12-22.
19. Kazmierczak KM, Biedenbach DJ, Hackel M, et al. Global dissemination of blaKPC into bacterial species beyond Klebsiella pneumoniae and in vitro susceptibility to ceftazidime-avibactam and aztreonam-avibactam. Antimicrob Agents Chemother 2016;60(8):4490-500.
20. Lee C-R, Lee JH, Park KS, Kim YB, Jeong BC, Lee SH. Global dissemination of carbapenemase-producing Klebsiella pneumoniae: epidemiology, genetic context, treatment options, and detection methods. Front Microbiol 2016;7:895.
21. Spyropoulou A, Papadimitriou-Olivgeris M, Bartzavali C, et al. A ten-year surveillance study of carbapenemase-producing Klebsiella pneumoniae in a tertiary care Greek university hospital: predominance of KPC-over VIM-or NDM-producing isolates. J Med Microbiol 2016;65(3):240-6.
22. Wiseman LR, Wagstaff AJ, Brogden RN, Bryson HM. Meropenem. A review of its antibacterial activity, pharmacokinetic properties and clinical effcacy. Drugs 1995;50(1):73-101.
23. Naderi P, Shirani K, Soltani R, Khorvash F, Naji Esfahani SS. Meropenem utilization evaluation in a referral teaching hospital in Iran. J Res Pharm Pract 2018;7(2):83-7.
24. Yong D, Lee K, Yum JH, et al. Imipenem-EDTA disk method for differentiation of metallo-beta-lactamase-producing clinical isolates of Pseudomonas spp. and Acinetobacter spp. J Clin Microbiol 2002;40(10):3798-801.
25. Lee K, Ha GY, Shin BM, et al. Metallo-beta-lactamase-producing gram-negative bacilli in Korean Nationwide Surveillance of Antimicrobial Resistance group hospitals in 2003: Continued prevalence of VIM-producing Pseudomonas spp. And increase of IMP-producing Acinetobacter spp. Diagn Microbiol Infect Dis 2004;50(1):51-8.
26. Khan MU, Yousuf RI, Shoaib MH. Drug utilization evaluation of meropenem and correlation of side effects with renal status of patients in a teaching based hospital. Pak J Pharm Sci 2014;27(5 Spec no):1503-8.
27. Dew R.S, Radji M, Andalusia R. Evaluation of Antibiotic Use Among Sepsis Patients in an Intensive Care Unit A cross-sectional study at a referral hospital in Indonesia. Sultan Qaboos Univ Med J 2018;18(3):e367-e373.
|Issue||Vol 9 No 1 (2021): Winter 2021|
|Drug Utilization Review; Drug Utilization, Evaluation; Anti-Bacterial Agents; Intensive Care Units|
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