Patra Shantanu K, Mishra Shakti B, Rath Arun, Samal Samir, Iqbal Sheikh Nurul
Department of Critical Care Medicine, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India.
Indian J Crit Care Med. 2020 Oct;24(10):938-942. doi: 10.5005/jp-journals-10071-23552.
High utilization of antimicrobial agent (AMA) and inappropriate usage in an intensive care unit (ICU) intensifies resistant organism, morbidity, mortality, and treatment cost. Prescription audit and active feedback are a proven method to check the irrational prescription. To analyze and compare the utilization of drugs, the World Health Organization (WHO) proposed daily defined dose (DDD)/100 patient days and days of therapy (DOT)/100 patient days to measure utilization of AMAs. Data of AMAs utilization are required for planning an antibiotic policy and for follow-up of intervention strategies.
A prospective observational study was conducted for 1 year from July 2018 to June 2019 and the data obtained from ICU of a tertiary care hospital. The demographic data, the disease data, and the utilization of different classes of AMAs [WHO-Anatomical Therapeutic Chemical (ATC) classification] as well as their cost were recorded. Total number of patient days, DDD, DDD/100 patient days, and DOT/100 patient days were calculated as proposed by the WHO. Statistical analysis was performed using statistical software SPSS version 25.0. The descriptive analysis was performed using summary statistics median [interquartile range (IQR)].
A total 939 patients were included, out of them 332 (35.4%) were female. The median age of the total patients was 58 (45-70). The median length of stay in ICU was 3 days. Mortality rate during our study period was 38.6%. The highly utilized AMAs in our study was ceftriaxone (36.95 DDD/100 patient days) followed by piperacillin/tazobactam (31.57), meropenem (26.4), doxycycline (21.53), and polymyxin B (21.38). The association between APACHE II and SOFA score with use of restricted antibiotics found to be statistical significant ( value 0.018 and 0.000, respectively). The cost of antibiotics per patient and patient days were $449.97 and $93.77, respectively, while median value of total cost was $2,343.26.
Ceftriaxone was the highest utilized AMA. The risk of receiving restricted antibiotics intensified with increasing prevalence of multidrug resistance bacteria and associated comorbidities. High treatment cost is responsible for higher utilization of restricted antibiotics in ICU.
Patra SK, Mishra SB, Rath A, Samal S, Iqbal SN. Study of Antimicrobial Utilization and Cost of Therapy in Medicine Intensive Care Unit of a Tertiary Care Hospital in Eastern India. Indian J Crit Care Med 2020;24(10):938-942.
重症监护病房（ICU）中抗菌药物（AMA）的高使用率和不当使用会加剧耐药菌的产生、发病率、死亡率以及治疗成本。处方审核和积极反馈是检查不合理处方的有效方法。为了分析和比较药物的使用情况，世界卫生组织（WHO）提出了限定日剂量（DDD）/100患者日和治疗天数（DOT）/100患者日来衡量AMA的使用情况。AMA使用数据对于制定抗生素政策和干预策略的随访至关重要。
于2018年7月至2019年6月进行了为期1年的前瞻性观察研究，数据来自一家三级护理医院的ICU。记录了人口统计学数据、疾病数据、不同类别的AMA（WHO解剖治疗化学（ATC）分类）的使用情况及其成本。按照WHO的提议计算患者总天数、DDD、DDD/100患者日和DOT/100患者日。使用统计软件SPSS 25.0进行统计分析。描述性分析采用汇总统计中位数[四分位间距（IQR）]。
共纳入939例患者，其中332例（35.4%）为女性。所有患者的中位年龄为58岁（45 - 70岁）。在ICU的中位住院时间为3天。我们研究期间的死亡率为38.6%。我们研究中使用量最高的AMA是头孢曲松（36.95 DDD/100患者日），其次是哌拉西林/他唑巴坦（31.57）、美罗培南（26.4）、多西环素（21.53）和多粘菌素B（21.38）。发现急性生理学与慢性健康状况评分系统II（APACHE II）和序贯器官衰竭评估（SOFA）评分与使用限制级抗生素之间的关联具有统计学意义（P值分别为0.018和0.000）。每位患者和每患者日的抗生素成本分别为449.97美元和93.77美元，而总成本的中位值为2343.26美元。
头孢曲松是使用量最高的AMA。随着多重耐药菌和相关合并症患病率的增加，接受限制级抗生素的风险也在增加。高治疗成本是ICU中限制级抗生素高使用率的原因。
Patra SK, Mishra SB, Rath A, Samal S, Iqbal SN. 印度东部一家三级护理医院内科重症监护病房抗菌药物使用及治疗成本研究。《印度重症监护医学杂志》2020;24(10):938 - 942。
