Comparison of the defined daily dose and days of treatment methods for evaluating the consumption of antibiotics and antifungals in the intensive care unit

Background: Antimicrobial stewardship programs (ASPs) are collaborative efforts to optimize antimicrobial use in healthcare institutions through evidence-based quality improvement strategies. With regard to critically ill patients, appropriate antimicrobial usage is of significance, and any delay in therapy increases their risk of mortality. Therefore, the implementation of structured multidisciplinary ASPs in critical care settings is of the utmost importance to promote the judicious use of antimicrobials.Methods: This quasi-experimental study evaluating a multidisciplinary ASP in a 20-bed critical care setting was conducted from January 1, 2016 to July 31, 2017. Outcomes were compared nine months before and after ASP implementation. The national antimicrobial stewardship toolkit by Ministry of health was reviewed and the hospital antibiotic prescribing policy was accordingly modified. The antimicrobial stewardship algorithm (Start Smart and Then Focus) and an ASP toolkit were distributed to all intensive care unit staff. Prospective audit and feedback, in addition to prescribing forms for common infectious diseases and education, were the primary antimicrobial strategies.Results: We found that the mean total monthly antimicrobial consumption measured as defined daily dose per 100 bed days was reduced by 25% (742.86 vs. 555.33; p = 0.110) compared to 7% in the control condition (tracer medications) (35.35 vs. 38.10; p = 0.735). Interestingly, there was a negative impact on cost in the post-intervention phase. Interestingly, the use of intravenous ceftriaxone measured as defined daily dose per 100 bed days was decreased by 82% (94.32 vs. 16.68; p = 0.008), whereas oral levofloxacin use was increased by 84% (26.75 vs. 172.29; p = 0.008) in the intensive care unit.Conclusion: Overall, involvement of higher administration in multidisciplinary ASP committees, daily audit and feedback by clinical pharmacists and physicians with infectious disease training, continuous educational activities about antimicrobial use and resistance, use of local antimicrobial prescribing guidelines based on up-to-date antibiogram, and support from the intensive care team can optimize antibiotic use in Saudi healthcare institutions.

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Antibiotic Utilization Pattern in the Intensive Care Unit of Tertiary Hospital in West Java, Indonesia

International Journal of Integrated Health Sciences ◽

10.15850/ijihs.v7n2.1633 ◽

2019 ◽

Vol 7 (2) ◽

pp. 81-87

Author(s):

Taradharani Wikantiananda ◽

Adi Imam Tjahjadi ◽

Reza Widianto Sudjud

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Anatomical Therapeutic Chemical ◽

Antibiotic Use ◽

Tertiary Hospital ◽

Defined Daily Dose ◽

Antibiotic Utilization ◽

Daily Dose ◽

Bed Days ◽

International Measurement

Objective: To find out the pattern of antibiotic utilization in intensive care unit (ICU). The high use of antibiotics in intensive care may increase antibiotic resistance. Methods: This was a retrospective study with total sampling method from patients who were treated in ICU in the period of January to June 2016. Selected data is processed using the Anatomical Therapeutic Chemical (ATC) Classification/Defined Daily Dose (DDD) system as an international measurement standard for analyzing and comparing usage applied by the WHO. Results: The results showed that of the 57 medical records collected, the total antibiotic use was 295.72 DDD/100 bed-days. Levofloxacin, meropenem, ceftriaxone, ceftazidime, and metronidazole were the five maximally utilized antibiotics with 143.18, 49.88, 30.62, 19.74, dan 16.99 DDD/100 bed-days respectively. Conclusion: The most frequently used of antibiotics is ceftriaxone, used in 54.39% of patients. Whereas in number, the most widely used antibiotic is levofloxacin with a total of 143.18 DDD/100 bed-days.

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Effect of Weekly Antibiotic Round on Antibiotic Use in the Neonatal Intensive Care Unit as Antibiotic Stewardship Strategy

Frontiers in Pediatrics ◽

10.3389/fped.2020.604244 ◽

2020 ◽

Vol 8 ◽

Author(s):

Bo Wang ◽

Geng Li ◽

Fei Jin ◽

Jingwen Weng ◽

Yaguang Peng ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Phase 1 ◽

Antibiotic Use ◽

Defined Daily Dose ◽

Phase 2 ◽

Daily Dose ◽

Predicted Values

Background: Antibiotics are commonly used in the neonatal intensive care unit (NICU). The objective was to observe the effect of weekly antibiotic round in NICU (WARN) to the antibiotic use in NICU.Methods: A retrospective observational study was performed. Departmental-level diagnosis categories and the parameters of antibiotic usage in NICU for the period of 2016-2017 (Phase 1) and 2018-2019 (Phase 2) were collected. WARN in NICU was started since January 2018. A time series forecasting was used to predict the quarterly antibiotic use in Phase 2, based on data from Phase 1. The actual antibiotic use of each quarter in Phase 2 was compared with the predicted values.Results: Totally 9297 neonates were included (4743 in Phase 1, 4488 in Phase 2). The composition of the disease spectrum between Phase 1 and Phase 2 was not different (P > 0.05). In Phase 1 and Phase 2, the overall antibiotic rate was 94.4 and 74.2%, the average accumulative defined daily dose per month was 199.00 ± 55.77 and 66.80 ± 45.64, the median antibiotic use density per month was 10.31 (9.00-13.27) and 2.48 (1.92-4.66), the median accumulative defined daily dose per case per month was 0.10 (0.09-0.13) and 0.03 (0.02-0.47), the number of patients who received any kind of antibiotic per 1000 hospital days per month was 103.45 (99.30-107.48) and 78.66 (74.62-82.77), rate of culture investigation before antibiotics was 64 to 92%, respectively, and all were better than the predicted values (P < 0.01).Conclusion: The implementation of periodical antibiotic rounds was effective in reducing the antibiotics use in the NICU.

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Antibiotic utilization, sensitivity, and cost in the medical intensive care unit of a tertiary care teaching hospital in Nepal

SAGE Open Medicine ◽

10.1177/20503121211043710 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110437

Author(s):

Nirmal Raj Marasine ◽

Shakti Shrestha ◽

Sabina Sankhi ◽

Nabina Paudel ◽

Ashish Gautam ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Teaching Hospital ◽

Medical Intensive Care Unit ◽

Tertiary Care ◽

Defined Daily Dose ◽

Tertiary Care Teaching Hospital ◽

Care Teaching ◽

Antibiotic Utilization ◽

Medical Intensive Care

Background: High utilization and irrational use of antibiotics in an intensive care unit increases microbial resistance, morbidity, mortality, and costs. Objective: This study aimed to evaluate the utilization, sensitivity and cost analysis of antibiotics used in the medical intensive care unit of a tertiary care teaching hospital of Nepal. Methods: A prospective cohort study was conducted on patients admitted to the medical intensive care unit at a tertiary care teaching hospital in central Nepal from July to September 2016. Antibiotic utilization, defined daily dose per 100 bed-days and the cost of antibiotics per patient were calculated. Descriptive statistics were performed using IBM-SPSS 20.0. Results: A total of 365 antibiotics were prescribed in 157 patients during the study period, with an average of 2.34 prescriptions per patient. Total antibiotic utilization in terms of defined daily dose per 100 bed-days was 49.5. Piperacillin/tazobactam (45.2%) was the most commonly prescribed antibiotic, and meropenem was the most expensive antibiotics (US$4440.70). The median (interquartile range) cost of antibiotics used per patient was US$47.67 (US$63.73). Escherichia coli, Acinetobacter, and Pseudomonas sp. were the common organisms isolated and were found to be resistant to some of the commonly used antibiotics. Conclusion: This study suggests that the utilization and cost of antibiotics are high in medical intensive care unit of the hospital and E. coli was resistant to multiple antibiotics. The findings highlight an urgent need for the implementation of antibiotic stewardship program in order to improve antibiotic utilization in such hospital settings.

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Characteristics of Microbial Factors of Healthcare-Associated Infections Including Multidrug-Resistant Pathogens and Antibiotic Consumption at the University Intensive Care Unit in Poland in the Years 2011–2018

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17196943 ◽

2020 ◽

Vol 17 (19) ◽

pp. 6943

Author(s):

Agnieszka Litwin ◽

Olga Fedorowicz ◽

Wieslawa Duszynska

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Multidrug Resistant ◽

Defined Daily Dose ◽

Gram Negative Bacteria ◽

Healthcare Associated Infections ◽

Gram Negative ◽

Enterococcus Spp ◽

Healthcare Associated ◽

The University

Introduction: In recent years, an increase in healthcare-associated infections (HAIs) caused by resistant pathogens, which is a clinically troublesome trend, has been observed. The aim of the study was to analyze the microbial factors of HAIs and the drug resistance of microorganisms to selected antibiotics and their consumption. Material and Methods: The retrospective study included 3708 patients hospitalized in the intensive care unit (ICU) of the University Teaching Hospital in Wroclaw, who were diagnosed with 742 HAIs in the period from 1 January 2011 to 31 December 2018. The aim of the study was the analysis of microorganisms isolated in the respective clinical forms of HAIs, including the occurrence of “alert pathogens”, presence of multidrug-resistant (MDR) strains, and consumption of selected antibiotics. Findings: During the study period, 846 microorganisms were cultured in patients with HAIs, and among them, Acinetobacter baumannii MDR represented 31.8%; Klebsiella pneumoniae ESBLs, 11.3%; Pseudomonas aeruginosa MDR, 4.1% and MRSA, 2.2%; and Enterococcus spp. vancomycin-resistant enterococci (VRE), 1.3%. Among all the pathogens, Gram-negative bacteria (GNB) were dominant (71.6%). Gram-positive bacteria and fungi accounted for 21.6% and 7%, respectively. The total number of strains responsible for ventilator-associated pneumonia (VAP), urinary tract infection (UTI), and central line-associated blood stream infection (CLA-BSI) was as follows: 458 (54.1%), 274 (32.4%), and 114 (13.5%), respectively. Among the etiological factors of VAP, there was a prevalence of A. baumannii MDR (41.9%), as well as in the case of UTI (21.9%). With regards to CLA-BSI, MRCNS (29.8%) was the dominant pathogen. The “alert pathogens” accounted for 54.7% of all the analyzed strains. The MDR strains represented 72.6% and 9.7% among A. baumannii and P. aeruginosa, respectively. In the years 2011 vs. 2018, an increase in infections with MDR bacilli was observed, 34.6% vs. 61.0% (p = 0.0008), respectively, including A. baumannii MDR 16.54% vs. 34.56 % (p = 0.0009) and Enterobacterales ESBL+/AMPC 11.8% vs. 15.44 % (p = 0.3921). Resistance to methicillin was confirmed in 35.2% of S. aureus strains. Resistance to vancomycin was found among 30.9% of Enterococcus spp. The observed period was marked by an increase in the consumption of carbapenems: 197.7 vs. 235.9 defined daily dose (DDD)/1000 patients-days. Conclusions: Gram-negative bacteria were found to be dominant pathogens in healthcare-associated infections. The most frequently cultured pathogens were multidrug-resistant A. baumannii, K. pneumoniae ESBL(+), and P. aeruginosa. The study showed an increase in the incidence of “alert pathogens” and MDR bacilli, as well as the tendency of a growing resistance to antibiotics during the observed period. Microbiological analysis of HAIs and the consumption of antibiotics is the necessary element of the proper antibiotic policy in hospitals.

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Vancomycin as a single daily dose in critically ill patients on an intensive care unit

Critical Care ◽

10.1186/cc810 ◽

2000 ◽

Vol 4 (Suppl 1) ◽

pp. P90

Author(s):

S Grundler ◽

N Stallard ◽

A Paull ◽

MN Smithies

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Single Daily Dose ◽

Daily Dose

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Pharmacoepidemiology of Furosemide in the Neonatal Intensive Care Unit

Neonatology ◽

10.1159/000510657 ◽

2020 ◽

pp. 1-5

Author(s):

Elizabeth J. Thompson ◽

Daniel K. Benjamin ◽

Rachel G. Greenberg ◽

Karan R. Kumar ◽

Kanecia O. Zimmerman ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Cumulative Dose ◽

Neonatal Intensive Care ◽

Total Duration ◽

Maximum Daily Dose ◽

Daily Dose ◽

Median Cumulative Dose ◽

Short Courses

Background: Furosemide is commonly used off-label in the neonatal intensive care unit (NICU), but current dosing practices vary widely. Objectives: To describe dosing practices including route, dose, and duration of exposure to furosemide in a large number of community and tertiary NICUs across North America. Method: Using the Pediatrix Medical Group Clinical Data Warehouse, we identified infants who received ≥1 dose of furosemide between 1997 and 2016. We excluded infants with incomplete dosing data. We calculated average daily furosemide dose, cumulative dose, total days of exposure, and maximum daily dose. We compared dosing between infants born at <32 weeks gestational age (GA) and ≥32 weeks GA. Results: A total of 18,572 infants had complete dosing data. The median (interquartile value) postnatal age at first exposure was 11 days (4, 26), the median maximum daily dose was 1.0 mg/kg (0.97, 1.6), the median average daily dose was 1.0 mg/kg (0.88, 1.1), and the median cumulative dose was 2.0 mg/kg (1.0, 4.5). The median total duration of exposure was 2 days (1, 4). A total of 177 (1%) infants received ≥4 mg/kg/day of furosemide. Infants born <32 weeks GA were an older age at initial furosemide exposure compared to those born ≥32 weeks GA: 19 versus 4 days, p < 0.001. Conclusions: Most infants received short courses of furosemide within the labeled dosing parameters. Further studies are needed to assess the safety and efficacy of furosemide in the NICU.

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Prospective study of the prescribing pattern of antibiotics and their outcome in patients admitted to intensive care unit at tertiary center

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20201750 ◽

2020 ◽

Vol 9 (5) ◽

pp. 743

Author(s):

Pavithra H. G. ◽

Syed Mohsin Ahmed ◽

Krishnamurthy H. A.

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Defined Daily Dose ◽

Prescription Data ◽

Prescribing Pattern ◽

Economic Implications ◽

Use Of Resources ◽

Tertiary Center ◽

Empirical Antibiotics ◽

Periodic Evaluation

Background: Antibiotics are currently the most commonly prescribed drugs in hospitals, worldwide. overuse of antibiotics has important economic implications. Periodic evaluation of drug utilization in the intensive care unit (ICU) is necessary for optimization of health care system, proper use of resources and making prescription policy because ICU is considered as the epi-center of antimicrobial resistance. The aim of this study is to evaluate antibiotic prescription and consumption patterns at admission into intensive care unit and to know the average costs of antibiotics.Methods: The prescription data on 250 consecutive patients at admission into the ICU was audited from January to March 2019. Total antibiotics, dose, route and cost of antibiotics were noted and the defined daily dose/100 bed days of most common antibiotics were calculated. Statistical analysis is done using SPSS software.Results: A total of 689 antibiotics were prescribed in the 250 patients studied that is, an average of 2.28 antibiotics/prescription. Empirical antibiotics were prescribed to all the patients admitted to ICU. Average cost of the antibiotics was rupees 163.89 per patients. The most commonly prescribed antibiotic at ICU admission was ceftriaxone (62%) of all prescription. Second most common is metronidazole (32%). In this study, 76 patients recovered while 174 patients expired.Conclusions: Our study reveals that antibiotics are widely prescribed in critically ill patients and form significant drug consumed in the ICU. At admission elderly patients are prescribed >2 antibiotics and prescribing antibiotics where the cost of antibiotic is high.

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The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00097 ◽

2019 ◽

Vol 4 (6) ◽

pp. 1507-1515

Author(s):

Lauren L. Madhoun ◽

Robert Dempster

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Hospital Discharge ◽

Neonatal Intensive Care ◽

Oral Feeding ◽

Medical Attention ◽

Primary Role ◽

Speech Language Pathologists ◽

The Family

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

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