Incidence and susceptibility of aerobic Gram-negative bacilli from 20 Canadian intensive care units: 1989-1993

Drug utilization pattern in critical care unit in a tertiary care teaching hospital in India

Aims:

The aim of this study is to evaluate the drug utilization pattern and pharmacoeconomic analysis in critical care unit (CCU).

Materials and Methods:

Indoor case papers of patients admitted in CCU between January 2008 and December 2010 were analyzed for demographic variables; indications; duration of CCU stay; proportion of common drugs used. Use of antimicrobials was evaluated based on the culture report and empirical regimen used. Defined daily dose (DDD)/100 bed-days were calculated. Various World Health Organization prescribing indicators were evaluated. Cost of drugs was calculated from Indian Drug Review (2010).

Results:

A total of 397 cases were evaluated with a mean age of 44.62 years (95% confidence interval [CI]: 42.56-46.69). Average duration of CCU stay was 4.15 days (95% CI: 3.79-4.51). The average number of drugs prescribed per patient was 13.54 (95% CI: 13.05-14.04). Total drug utilization in terms of DDD/100 bed-days was 226.27. Metronidazole, cefotaxime, atropine, adrenaline, dopamine, dobutamine, deriphyllin, ranitidine, metoclopramide and furosemide were prescribed in more than 30% cases. Number of antimicrobials prescribed per patient was 2.50 (95% CI: 2.37-2.66). Cefotaxime + metronidazole (26.70%) were the most common empirical regimen used. Average cost of treatment per patient was Rs 3225.70 (95% CI: 2749.8-3701.6). Higher economic burden was noted among expired patients and admitted due to medical + surgical indication (P < 0.05).

Conclusion:

Poly-pharmacy and use of antimicrobials without culture report is a common problem in CCU.

Microbiological surveillance and parenteral antibiotic use in a critical care unit

OBJECTIVE

To evaluate parenteral antibiotic utilization and bacterial resistance patterns in a critical care unit (CrCU).

DESIGN

Descriptive, prospective audit of infection site, culture and antimicrobial susceptibility test results, parenteral antibiotic usage and duration, total antibiotic acquisition costs, and length of stay.

SETTING

A 17-bed medical-surgical CrCU in a tertiary care teaching hospital in Metropolitan Toronto.

PATIENTS

Two hundred and fifty-eight patients admitted to the CrCU between May 1995 and April 1996 who received antimicrobial therapy.

RESULTS

The most frequently prescribed antibiotics were cefazolin (47%, 1098 g), gentamicin (33%,141 g) and ceftriaxone (20%, 255 g). The most common indications for antimicrobial therapy included surgical prophylaxis (34%) and pneumonia (35%). The following organisms were isolated from patients treated with antibiotics: Staphylococcus aureus (26%), Pseudomonas aeruginosa (13%), enterococci (12%), Haemophilus influenzae (11%), Escherichia coli (11%), Enterobacter cloacae (8%) and other Gram-negative bacilli (19%). Only 9% of Gram-negative bacilli were resistant to aminoglycosides, 3% were resistant to ciprofloxacin and no extended-spectrum beta-lactamases or imipenem-resistance were detected. No vancomycin-resistant enterococci and only two methicillin-resistant Staphylococcus aureus isolates were identified.

CONCLUSIONS

Antibiotic use during the audit appeared appropriate for the specific clinical indications. Low levels of bacterial resistance were detected during the audit.