Antibiotic prescription and cost patterns in a general intensive care unit
Antibiotic prescription habits, cost pattern, and the prospective intervention in an Intensive Care Unit were analyzed.
Methods: Data on antibiotic utilization and costs were collected prospectively from individual electronic charts from August 2003 to January 2004, and retrospectively from August to December 2002.
Results: A total of 180 and 107 patients were surveyed in 2002 and 2003. In 2002, Piperacillin-Tazobactam (13.8%) and Imipenem/Cilastin (11.2%) were the most prescribed medications; while, in 2003, Vancomycin (12.6%) and Imipenem/Cilastin (11.3%) were prescribed, respectively. Total defined daily dose (DDD) and Drug Utilization 90% (DU90%) index for 2002 and 2003 were 2031.15 and 2325.90 DDDs (p>0.1) and 1777.57 and 2079.61 DU90%, respectively (p>0.1). The Median Total Cost /100 admission days (CI 95%) were NIS13,310 (11,110;18,420) and NIS13,860 (6,710;18,020) (p=0.66), respectively.
Conclusions: Interventional programs should focus on promoting infectious control with rational antibiotic prescription aimed at minimizing the future emergence of bacterial resistance and futile expenses.
2. Stevenson RC, Blackman SC, Williams CL, Bartzokas CA. Measuring the saving attributable to an antibiotic prescription policy. J Hosp Infect 1988; 11: 16-25.
3. Lesar TS, Briceland LL. Survey of antibiotic control policies in university-affiliated teaching institutions. Ann Pharmacother 1996; 30: 31-4.
4. Strum W. Effects of a restrictive antibiotics policy on clinical efficacy of antibiotics and susceptibility patterns of organisms. Eur J Microbiol Infect Dis 1990; 9: 381-9.
5. Niederman MS. Appropriate use of antimicrobial agents: Challenges and strategies for improvement. Crit Care Med 2003; 31: 608- 16.
6. Kollef MH. Optimizing antibiotic therapy in the intensive care unit setting. Crit Care 2001; 5: 189-95.
7. Pulcine C, Pradier C, Samat-Long C, Hyvernat H, et al. Factors associated with adherence to infectious diseases advice in two intensive care units. J Antimicrob Chemother 2006; 57: 546- 50.
8. Lemmen SW, Hafner H. Influence of an infectious disease service on antibiotic prescription behavior and selection of multiresistant pathogens. Infection 2000; 28: 384: 7.
9. Krivoy N, Mattalon N. Antimicrobial utilization pattern in a hematologic intensive care unit. J Pharm Technol 2001; 17: 15-18.
10. Guidelines for ATC classifications and DDD assignment. WHO Collaborating Center for Drug Statistic Methodology. Oslo (www.whocc.no).
11. Lunde PKM, Andrew M, Baksaas I. Drug Utilization - an instrument in drug research. In Epidemiological concepts in clinical pharmacology. Kewitz H, Roots I, and Voight K (eds). Springer-Verlag: Berlin, 1987: 57-63.
12. Bergman U, Popa C, Tomson Y, Wettermark B, Einarson TR, Aberg H, Sjoqvist F. Drug Utilization 90% - A simple method for assessing the quality of drug prescribing. Eur J Clin Pharmacol 1998; 54: 113-8.
13. Wettermark B, Pehrsson A, Jinnerot D, Bergman U. Drug utilization 90% profiles - a useful tool for quality assessment of prescribing in primary health care in Stockholm. Pharmacoepidemiol Drug Saf 2003; 12: 499-510.
14. Bergman U, Andersson D, Frieberg A, et al. Kvalitertsutveckling: Kvalitetsindikatorer for lakemedelsforskrivningoch-hantering. Svanska Lakarsallskapert och Spri. Svensk Medicin Nr 66, 1999.
15. Besser RE. Antimicrobial prescribing in the United States: good news, bad news. Ann Intern Med 2003; 138: 605-6.
16. Bergman U, Wettermark B. Setting up and using the DU90% technique-a simple indicator for assessing the quality of drug prescribing. In Handbook of Drug Use Research Methodology, 1st Ed. McGavock H (ed). The United Kingdom Drug Utilization Research Group: Newcastle upon Tyne, 2000; 155-63.
17. Berild D, Mohseni A, Diep M, Jensenius M, Ringertz SH. Adjustment of antibiotic treatment according to the results of blood cultures leads to decreased antibiotic use and costs. J Antimicrob Chemother 2006; 57: 326-30.
18. Hanssens Y, Ismaeili BB. Antibiotic prescription pattern in a medical intensive care unit in Qatar. Saudi Med J 2005; 26: 1269-76.
19. Gendel I, Azzam ZS, Braun E, Levy Y, Krivoy N. Antibiotic utilization prevalence: prospective comparison between two medical departments in a tertiary care university hospital. Pharmacoepidemiol Drug Safety 2004; 13: 735-9.
20. Filius PMG, Liem TBY .An additional measure for quantifying antibiotic use in hospitals. J Antimicrob Chemother 2005; 55:805-8.
21. Lorian D .The need for surveillance for antimicrobial resistance. Infect Control Hosp Epidemiol 1995; 16: 638-41.
22. Winker MA, Flanaqin A. Infectious disease a global approach to a global problem. JAMA 1996; 275:245-6.
23. Shapiro M, Townsend.T, Rosen B, Kass.EH. Use of antimicrobial drugs in general hospitals pattern of prophylaxis. N Eng J Med 1979; 301: 351-55.
24. Erbay A, Bodur H, Akinci E, Colpan A. Evaluation of antibiotic use in intensive care units of a tertiary care hospital in Turkey. J Hosp Infect 2005; 59: 53-61.
25. Grohskoft LA, Huskins WC, Sinkowitz-Cochran R, Levine GL, Goldmann DA, Jarvis WR; the Pediatric Prevention Network. Use of antimicrobial agents in United States neonatal and pediatric intensive care patients. Pediatr Infect Dis J 2005; 24: 766-73.
26. Hartmann B, Junger A. Review of antibiotic drug use in a surgical ICU: Management with a patient data management system for additional outcome analysis in patients staying more than 24 hours. Clin Ther 2004; 16:195-9.
27. Lemmen SW. Influence of Infectious Disease consulting service on quality and cost of antibiotic prescriptions in a university hospital. Scand J Infect Dis 2001; 33: 219-20.
28. Thuamog M, Shortgen F, Zazempa V. Appropriate use of restricted antimicrobial agents in hospitals, the importance of empirical therapy and assisted reevaluation. J Antimicrob Chemother 2000; 46:501-8.
29. Kunin CM, Tupasi T, Craig WA. Use of antibiotics, a brief exposition of the problem and some tentative solutions. Ann Intern Med 1973; 79: 555-60.
30. Raz R, Farbstein Y, Hassin D, et al. The use of systemic antibiotics in seven community hospitals in northern Israel. J Infect 1998; 37:224-8.
31. Byl B, Clevenbergh P, Jacobs F, Struelens MJ, Zech F, Kentos A, Thys JP. Impact of infectious disease specialist and microbiological data on the appropriateness of antimicrobial therapy for bacteremia. Clin Infect Dis 1999; 29: 60-66.
32. 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; 46: 945-51.
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