The Pattern of Antibiotic Utilization in Intensive Care Units of a Tertiary Care Public Hospital
Abstract
Background: Resistance to antibiotics is increasing. Hospital overuse of antibiotics is a significant contributor to antibiotic resistance. A rational use of antibiotics is necessary to optimize the outcome of critically ill patients. The study aimed to examine the utilization pattern of antibiotics in the intensive care units (ICUs) of a tertiary care public hospital.
Methods: This observational study was conducted over eight months in the medical ICU (MICU), surgical ICU (SICU), and trauma ICU (TICU). Data regarding prescribed antibiotics, including name, content, dose, route of administration, and duration of treatment, were used to describe the pattern and estimate the consumption. The defined daily dose (DDD)/100 bed-days of each prescribed antibiotic was calculated.
Results: The three most frequently used antibiotics in all the ICUs were piperacillin + tazobactam (107 patients), Meropenem (74 patients), and Metronidazole (72 patients). The total utilization of antibiotics was 46.94, 53.91, and 38.84 DDD/100 bed-days in the TICU, SICU, and MICU wards, respectively. Antibiotics with the highest utilization (DDD/100 bed-days) in each ward were meropenem (13.47) in the SICU, piperacillin + tazobactam (10.64) in the TICU, and ceftriaxone (9.49) in the MICU.
Conclusion: The present study results indicated that the percentage share of different antibiotic drugs varied according to the type of ICU and disease. Penicillin combinations, cephalosporin, and carbapenems were the most commonly used antibiotic groups in all ICUs. High consumption of broad-spectrum antibiotics underscores the importance of stewardship programs to overcome the growing resistance to available effective antibiotics in ICUs.
Leuthner KD, Doern GV. Antimicrobial stewardship programs. J Clin Microbiol. 2013 Dec;51(12):3916-20.
Goldmann DA, Weinstein RA, Wenzel RP, Tablan OC, Duma RJ, Gaynes RP et al. Strategies to Prevent and Control the Emergence and Spread of Antimicrobial-Resistant Microorganisms in Hospitals. A challenge to hospital leadership. JAMA. 1996 Jan 17;275(3):234-40.
Paterson DL. The role of antimicrobial management programs in optimizing antibiotic prescribing within hospitals. Clin Infect Dis. 2006 Jan 15;42 Suppl 2:S90-5.
Campion M, Scully G. Antibiotic use in the intensive care unit: optimization and De-escalation. J Intensive Care Med. 2018;33(12):647–55.
De Waele JJ, Akova M, Antonelli M, Canton R, Carlet J, De Backer D, et al. Antimicrobial resistance and antibiotic stewardship programs in the ICU: insistence and persistence in the fight against resistance. A position statement from ESICM/ESCMID/WAAAR round table on multi-drug resistance. Intensive Care Med. 2018;44(2):189–96.
Neidell MJ, Cohen B, Furuya Y, Hill J, Jeon CY, Glied S, et al. Costs of healthcare- and community-associated infections with antimicrobial-resistant versus antimicrobial-susceptible organisms. Clin Infect Dis. 2012;55(6):807–15.
Saxena S, Priyadarshi M, Saxena A, Singh R. Antimicrobial consumption and bacterial resistance pattern in patients admitted in I. C. U. at a tertiary care center. J Infect Public Health. 2019;12(5):695–9.
Anand N, Nagendra Nayak IM, 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(5):274-9.
Wendie TF, Ahmed A, Mohammed SA. Drug use pattern using WHO core drug use indicators in public health centers of Dessie, North-East Ethiopia. BMC Med Inform Decis Mak. 2021 Jun 25;21(1):197.
WHO Collaborating Centre for Drug Statistics Methodology. ATC/DDD index. 2005 Available from: URL. http://www.whocc.no/atcddd/.
Tavallaee M, Fahimi F, Kiani S. Drug-use patterns in an intensive care unit of a hospital in Iran: An observational prospective study. Int J Pharm Pract. 2010;18:370–6.
Vincent JL, Marshall JC, Namendys Silva SA, François B, Martin Loeches I, Lipman J, et al. Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit. Lancet Respir Med. 2014 May;2(5):380-6.
Kumar P, Renuka MK, Kalaiselvan MS, Arunkumar AS. Outcome of Noncardiac Surgical Patients Admitted to a Multidisciplinary Intensive Care Unit. Indian J Crit Care Med. 2017 Jan;21(1):17-22.
Tiwari J, Rawat S, Jha A, Pandey R. Mortality Profile of Critical Patients in Medical Intensive Care Unit of Government Medical College of Central India. Journal of Clinical and Diagnostic Research. 2021 Apr, 15(4): OC05-OC08.
Al-Zakwani, I., Al-Thuhli, M., Al-Hashim, A., & Al Balushi, K. A. (2017). Drug utilization pattern in an intensive care unit at a tertiary care teaching hospital in Oman. Asian Journal of Pharmaceutical and Clinical Research, 10(2), 194-197.
Abdelwahed HS, Martinez FE. ICU Length of Stay and Factors Associated with Longer Stay of Major Trauma Patients with Multiple Rib Fractures: A Retrospective Observational Study. Crit Care Res Pract. 2022;2022:6547849.
Bergmans DC, Bonten MJ, Gaillard CA, van Tiel FH, van der Geest S, de Leeuw PW, et al. Indications for antibiotic use in ICU patients: a one-year prospective surveillance. J Antimicrob Chemother. 1997 Apr;39(4):527-35.
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 Aug;46(8):945-51.
Silva CD, Silva Júnior M. Strategies for appropriate antibiotic use in intensive care unit. Einstein (Sao Paulo). 2015;13(3):448-53.
Kayambankadzanja RK, Lihaka M, Barratt-Due A, Kachingwe M, Kumwenda W, Lester R, et al. The use of antibiotics in the intensive care unit of a tertiary hospital in Malawi. BMC Infect Dis. 2020;20(1):776.
Mali NB, Deshpande SP, Tullu MS, Deshmukh CT, Gogtay NJ, Thatte UM. A prospective antibacterial utilization study in pediatric intensive care unit of a tertiary referral center. Ind J Crit Care Med. 2018; 22(6):422–426.
Remschmidt C, Schneider S, Meyer E, Schroeren-Boersch B, Gastmeier P, Schwab F. Surveillance of antibiotic use and resistance in intensive care units (SARI). Dtsch Arztebl Int. 2017;114(50):858–865.
Santosh EF, Lauria-pires L, Pereira MG, Silva AE. Use of Antibacterial Agents in an Intensive Care Unit in a Hospital in Brazil. Braz J Infect Dis. 2007; 11(3): 355-9.
Williams A, Mathai AS, Phillips AS. Antibiotic prescription patterns at admission into tertiary level intensive care unit in Northern India. J pharm Bioall Sci. 2011; 3(1): 531-6.
Patel MK, Barvaliya MJ, Patel TK, Tripathi CB. 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.
| Files | ||
| Issue | Vol 13, No 2 (Spring 2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jpc.v13i2.19310 | |
| Keywords | ||
| Antibiotics Tertiary Care Hospital Intensive Care Units Consumption | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
