scholarly journals Utilisation of antimicrobial agents in intensive care unit at a tertiary care teaching hospital in eastern India

2019 ◽  
Vol 8 (9) ◽  
pp. 1951
Author(s):  
Rajendra Kumar Panda ◽  
P. Ansuman Abhisek ◽  
Lalit Mohan Sika ◽  
Shweta Supriya Pradhan ◽  
Sidharth Srabana Routray ◽  
...  
Keyword(s):  
Intensive Care ◽  
Antimicrobial Agents ◽  
Multinomial Logistic Regression ◽  
Tertiary Care ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Defined Daily Dose ◽  
Female Ratio ◽  
Utilisation Pattern ◽  
Bed Days

Background: Antimicrobial agents (AMAs) are the most frequently used drugs in the intensive care units (ICU) and regular auditing can prevent the development of resistance to AMAs, reduce the cost and incidence of adverse drug reactions. The present study was conducted to assess the drug utilisation pattern by measuring the defined daily dose (DDD) per 100 bed days for the AMAs used and their correlation with the APACHE score II.Methods: This was a prospective observational study, conducted in the Central ICU of SCB Medical College and Hospital, Cuttack, Odisha for 4 months. Data regarding demographic profile, diagnosis, APACHE II score, microbiologic investigation, length of stay, outcome and utilisation pattern of AMAs assessing anatomic therapeutic chemical (ATC) classification and measuring the antimicrobial consumption index (ACI) equal to DDD per 100 bed days were collected and subjected to descriptive analysis. Multinomial logistic regression model was used to predict probabilities of different possible outcomes of categorically distributed variables and independent variables.Results: Mean age of study population was 44.70±14.814 with male and female ratio of 1.63:1. Septicaemia was the most common cause of admission. AMAs were prescribed to 92.66% of patients during their stay which constitutes 37.32% of the total drugs used. The DDD per 100 bed days for the AMAs were 118.59 and ceftriaxone was found to be most frequently used. Patients having higher APACHE II score received more no of AMAs (4.20±1.30). Patients having low APACHE II Scores received less number of antibiotics as compared to patients having higher score.Conclusions: AMAs were prescribed to 92.66% patients in the central ICU and there is significant relation between the APACHE II score and number of AMAs prescribed.

scholarly journals The comparison of apache II and apache IV score to predict mortality in intensive care unit in a tertiary care hospital

2019 ◽  
Vol 7 (5) ◽  
pp. 1598
Author(s):  
Vidya S. Nagar ◽  
Basavaraj Sajjan ◽  
Rudrarpan Chatterjee ◽  
Nitesh M. Parab
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tertiary Care ◽  
Mortality Rates ◽  
Mortality Prediction ◽  
Apache Ii ◽  
Youden Index ◽  
Apache Ii Score ◽  
Care Hospital ◽  
Apache Iv

Background: The prognostication of critically ill patients, in a systematic way, based on definite objective data is an integral part of the quality of care in Intensive Care Unit (ICU). Acute physiology and chronic health evaluation (APACHE) scoring systems provide an objective means of mortality prediction in Intensive Care Unit (ICU). The aims of this study were to compare the performance of APACHE II and APACHE IV in predicting mortality in our intensive care unit (ICU).Methods: A prospective observational study was conducted in a 13 bedded intensive care unit (ICU) of a tertiary level teaching hospital. All the patients above the age of 12 years, irrespective of diagnosis managed in ICU for >24hours were enrolled. APACHE II and APACHE IV scores were calculated based on the worst values in the first 24hours of admission. All enrolled patients were followed up, and outcome was recorded as survivors or non survivors. Observed mortality rates were compared with predicted mortality rates for both the APACHE II and APACHE IV. Receiver operator characteristic curves (ROC) were used to compare accuracy of the two scores.Results: APACHE II score of the patients ranged from 1 to 32 and APACHE IV score of the patients ranged from 25 to 142. There was good correlation between APACHE II and APACHE IV scores with the spearman’s rho value of 0.776 (P<0.01). Discrimination for APACHE II and APACHE IV models were good with area under ROC curve of 0.805 and 0.832 respectively. APACHE IV was more accurate than APACHE II in this regard. The cut-off point with best Youden index for APACHE II was 17 and for APACHE IV were 72 respectively for predicting mortality.Conclusions: Discrimination was better for APACHE IV than APACHE II model however Calibration was better for APACHE II than APACHE IV model in present study. There was good correlation between the two models observed in present study.

scholarly journals Atrial Fibrillation in a Tertiary Care Multidisciplinary Intensive Care Unit—Incidence and Risk Factors

2007 ◽  
Vol 35 (5) ◽  
pp. 707-713 ◽  
Author(s):  
S. Arora ◽  
I. Lang ◽  
V. Nayyar ◽  
E. Stachowski ◽  
D. L. Ross
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Confidence Interval ◽  
Tertiary Care ◽  
Multivariate Logistic Regression Analysis ◽  
Apache Ii ◽  
Resource Utilisation ◽  
Apache Ii Score

Atrial fibrillation is a common arrhythmia in an intensive care unit. We performed a prospective observational study over a period of three months, to study the incidence, risk factors and outcome of patients who develop atrial fibrillation in a multidisciplinary intensive care unit. All patients above the age of 50 years were eligible. Exclusion criteria were: cardiac or oesophageal surgery during current hospitalisation, atrial fibrillation at admission, implanted pacemaker and expected intensive care unit stay of less than 24 hours. Sixty-one patients were included in the study. Eighteen patients (29.5%, confidence interval 18-40) developed atrial fibrillation. Incidence of atrial fibrillation was 4.02 episodes per 100 patient days. Patients who developed atrial fibrillation had higher age (71.3 years vs. 63.2 years, P=0.001), severity of illness (APACHE II 25.4 vs. 20.0, P=0.005) and sepsis at admission (9/18 vs. 9/43, P=0.01). They also had higher in-hospital mortality (Risk ratio 2.7, 95% confidence interval 1.3-5.4). Standardised mortality ratio was higher in patients who developed atrial fibrillation (1.08 vs. 0.63). Patients who developed atrial fibrillation required a longer period of mechanical ventilation and inotropic support. Multivariate logistic regression analysis showed age > 75 years, APACHE II score >20 and sepsis at admission were independent predictors for development of atrial fibrillation in critically ill patients. Although atrial fibrillation by itself is unlikely to be the cause of higher mortality, it is likely to be a marker for increased mortality and resource utilisation in the intensive care unit.

scholarly journals Prescribing pattern and utilization of selected antimicrobials in a tertiary hospital of Nepal

2019 ◽  
Vol 1 (2) ◽  
pp. 96-102
Author(s):  
Upasana Acharya ◽  
Ravi Mahat ◽  
Subhash Prasad Acharya ◽  
Bishnu Pahari ◽  
Prashant Tripathi
Keyword(s):  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Defined Daily Dose ◽  
Care Hospital ◽  
Prescribing Pattern ◽  
Empiric Treatment ◽  
Bed Days ◽  
One Year ◽  
Increasing Trends

 Introduction: This study was done to understand the purpose of using higher grade antimicrobials in a one year period and to compare the consumption of commonly prescribed parenteral antimicrobial agents in four consecutive years in a tertiary care hospital of Nepal. Materials & Methods: A retrospective observational study was carried out to collect the information on prescription of selected six classes of antimicrobial for all admitted patients aged 2 years or above for a one-year period. Further, the antimicrobial consumption tool 2016 was used to calculate defined daily dose (DDD) per 100 bed days of commonly dispensed parenteral antimicrobials for four consecutive years. Results: A total of 2568 antimicrobial supply forms prescribing higher grades antimicrobials were analyzed. The indications for use of antimicrobials were mainly for empiric treatment. Among the infections being treated, lower respiratory tract infection (LRTI) was the most frequent cause. Piperacillin-tazobactam was most frequently prescribed followed by Meropenem. Also, DDD for commonly used parenteral antimicrobials showed increasing trends over four consecutive years. Conclusion: The prescription of higher grades of antimicrobial for empiric treatment and surgical prophylaxis need to be monitored. The rate of consumption of such antimicrobials could not be assessed due to lack of similar studies but the increase in DDD/100 bed days each year suggested the rise in consumption of antimicrobial in the same institution.

scholarly journals ANTIMICROBIAL AGENT’S UTILIZATION AND COST PATTERN IN MEDICAL INTENSIVE CARE UNIT OF A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 89-93
Author(s):  
SARTAJ HUSSAIN ◽  
SURAJ SINGH YADAV ◽  
KAMAL KUMAR SAWLANI ◽  
KAUSER USMAN ◽  
SANJAY KHATTRI
Keyword(s):  
Antimicrobial Agents ◽  
Anatomical Therapeutic Chemical ◽  
Tertiary Care ◽  
World Health ◽  
Apache Ii Score ◽  
Defined Daily Dose ◽  
Care Hospital ◽  
Total Treatment Cost ◽  
Cross Sectional ◽  
The Mean

Objective: The objective of this study was to evaluate the utilization and cost pattern of AMAs (Antimicrobial Agents) in the Medical ICU of a tertiary care teaching hospital, and to determine the predictor of antimicrobial number per day. Methods: A prospective cross-sectional study was carried out and a total of 101 patients were studied. The drugs were classified into different groups according to the World Health Organization’s ATC (Anatomical Therapeutic Chemical) Classification System.  Results: The mean [95% confidence interval (CI)] duration of ICU stay was 7.11 (5.70-8.52) days and the mortality rate in the ICU was 42.6%. The AMAs DDD (Defined Daily Dose) per 100 patient days and number of AMAs per prescription were 296.64 and 2.65, respectively. Piperacillin-tazobactam was the most commonly utilized AMAs followed by metronidazole, meropenem, fluconazole, and colistin. The mean number [95% CI] of AMAs, DDD, and cost (INR) per patient were 18.82 (14.05-23.59), 21.09 (15.36-26.81) and 25,827 (18,716-32,939) respectively. The AMAs constituted 88.53% of the total treatment cost. Meropenem was the most costly AMA (32.10% of the total AMAs cost) followed by imipenem-cilastatin (20.50%), colistin (14.65%), piperacillin-tazobactam (8.40%), and clindamycin (4.47%). The independent predictor for the antimicrobial number per day was acute physiology and chronic health evaluation II (APACHE-II) score at admission and nosocomial infections. Conclusion: The AMAs, DDD per 100 patient days, and number per prescription were higher. This leads to a higher cost of AMAs per patient and the AMAs cost out of the total cost as compared to previous studies. We suggest, there is a need to formulate and implement an antimicrobial restriction policy.

scholarly journals Severity and prognosis in intensive care: prospective application of the Apache II Index

1999 ◽  
Vol 117 (5) ◽  
pp. 205-214 ◽  
Author(s):  
Joel Isidoro Costa ◽  
José Luiz Gomes do Amaral ◽  
Masashi Munechika ◽  
Yara Juliano ◽  
José Gomes Bezerra Filho
Keyword(s):  
Intensive Care ◽  
Mortality Rate ◽  
Elective Surgery ◽  
Tertiary Care ◽  
Prognostic Index ◽  
Clinical Severity ◽  
Apache Ii ◽  
Sample Population ◽  
Significant Difference ◽  
Critical Patients

CONTEXT: The performance of each ICU needs to be assessed within the overall context of medical care, as well as by the institution which the ICU forms part of. Evaluation mechanisms in the field of intensive care have been developed that are recognized worldwide within the scientific literature. OBJECTIVE: To study outcomes from groups of critical patients and to compare their actual and estimated mortality rates. DESIGN: Prospective study of patients' outcomes. SETTING: A tertiary care unit for a period of 13 months (anesthesiology intensive care unit at the Escola Paulista de Medicina). PARTICIPANTS: 520 patients selected according to sex, age and nature of hospitalization. DIAGNOSTIC TEST: The modified APACHE II prognostic index was applied in order to assess clinical severity and anticipation of mortality in three groups who had non-surgical treatment, emergency surgery and elective surgery. MAIN MEASUREMENTS: The APACHE II index. RESULTS: The application of this index allowed patients to be stratified and expected death risks for both subgroups and the entire sample population to be calculated. The observed mortality rate was greater than the expected rate (28.5% versus 23.6%, respectively), with a statistically significant difference. The standardized mortality rate was 1.20. Patients who obtained scores above 25 presented a significant outcome towards death. The most severe and worst evolving cases were, in decreasing order: non-surgical, emergency surgical and scheduled surgical patients; the actual general mortality rate was higher than the expected one. CONCLUSIONS: The use of the APACHE II index made it possible to stratify critical patient groups according to the severity of their condition.

Assessing the Prescription Pattern of Antimicrobial Agents in Intensive Care Unit at Tertiary Care Hospital

2020 ◽  
Vol 2 (10) ◽  
pp. 1825-1830
Author(s):  
Avinash Khadela ◽  
Bhavin Vyas ◽  
Nancy Rawal ◽  
Heni Patel ◽  
Sonal Khadela ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antimicrobial Agents ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Prescription Pattern

scholarly journals Improvement of APACHE II score system for disease severity based on XGBoost algorithm

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yan Luo ◽  
Zhiyu Wang ◽  
Cong Wang
Keyword(s):  
Intensive Care ◽  
Hospital Mortality ◽  
Patient Outcomes ◽  
External Validation ◽  
Apache Ii ◽  
Validation Dataset ◽  
Apache Ii Score ◽  
Severity Scores ◽  
The Impact ◽  
Improve Patient

Abstract Background Prognostication is an essential tool for risk adjustment and decision making in the intensive care units (ICUs). In order to improve patient outcomes, we have been trying to develop a more effective model than Acute Physiology and Chronic Health Evaluation (APACHE) II to measure the severity of the patients in ICUs. The aim of the present study was to provide a mortality prediction model for ICUs patients, and to assess its performance relative to prediction based on the APACHE II scoring system. Methods We used the Medical Information Mart for Intensive Care version III (MIMIC-III) database to build our model. After comparing the APACHE II with 6 typical machine learning (ML) methods, the best performing model was screened for external validation on anther independent dataset. Performance measures were calculated using cross-validation to avoid making biased assessments. The primary outcome was hospital mortality. Finally, we used TreeSHAP algorithm to explain the variable relationships in the extreme gradient boosting algorithm (XGBoost) model. Results We picked out 14 variables with 24,777 cases to form our basic data set. When the variables were the same as those contained in the APACHE II, the accuracy of XGBoost (accuracy: 0.858) was higher than that of APACHE II (accuracy: 0.742) and other algorithms. In addition, it exhibited better calibration properties than other methods, the result in the area under the ROC curve (AUC: 0.76). we then expand the variable set by adding five new variables to improve the performance of our model. The accuracy, precision, recall, F1, and AUC of the XGBoost model increased, and were still higher than other models (0.866, 0.853, 0.870, 0.845, and 0.81, respectively). On the external validation dataset, the AUC was 0.79 and calibration properties were good. Conclusions As compared to conventional severity scores APACHE II, our XGBoost proposal offers improved performance for predicting hospital mortality in ICUs patients. Furthermore, the TreeSHAP can help to enhance the understanding of our model by providing detailed insights into the impact of different features on the disease risk. In sum, our model could help clinicians determine prognosis and improve patient outcomes.

scholarly journals Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit

2018 ◽  
Vol 46 (3) ◽  
pp. 1254-1262 ◽  
Author(s):  
Surat Tongyoo ◽  
Tanuwong Viarasilpa ◽  
Chairat Permpikul
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Serum Potassium ◽  
Critically Ill Patients ◽  
Medical Intensive Care Unit ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Mortality ◽  
Medical Intensive Care

Objective To compare the outcomes of patients with and without a mean serum potassium (K+) level within the recommended range (3.5–4.5 mEq/L). Methods This prospective cohort study involved patients admitted to the medical intensive care unit (ICU) of Siriraj Hospital from May 2012 to February 2013. The patients’ baseline characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, serum K+ level, and hospital outcomes were recorded. Patients with a mean K+ level of 3.5 to 4.5 mEq/L and with all individual K+ values of 3.0 to 5.0 mEq/L were allocated to the normal K+ group. The remaining patients were allocated to the abnormal K+ group. Results In total, 160 patients were included. Their mean age was 59.3±18.3 years, and their mean APACHE II score was 21.8±14.0. The normal K+ group comprised 74 (46.3%) patients. The abnormal K+ group had a significantly higher mean APACHE II score, proportion of coronary artery disease, and rate of vasopressor treatment. An abnormal serum K+ level was associated with significantly higher ICU mortality and incidence of ventricular fibrillation. Conclusion Critically ill patients with abnormal K+ levels had a higher incidence of ventricular arrhythmia and ICU mortality than patients with normal K+ levels.

APACHE II Score and Evaluation of Intensive Care Unit Patients

1994 ◽  
Vol 27 (2) ◽  
pp. 191
Author(s):  
Kyoung Min Lee ◽  
Gie Hoan Lee ◽  
Dae Ja Um ◽  
Ryoung Choi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Apache Ii ◽  
Apache Ii Score

scholarly journals Prognosis of Patients with Rheumatic Diseases Admitted to Intensive Care

2017 ◽  
Vol 45 (1) ◽  
pp. 67-72 ◽  
Author(s):  
M. Beil ◽  
S. Sviri ◽  
V. de la Guardia ◽  
I. Stav ◽  
E. Ben-Chetrit ◽  
...  
Keyword(s):  
Intensive Care ◽  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Matched Control ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Control Group ◽  
Control Groups ◽  
Predicting Outcome ◽  
And Gender

Variable mortality rates have been reported for patients with rheumatic diseases admitted to an intensive care unit (ICU). Due to the absence of appropriate control groups in previous studies, it is not known whether the presence of a rheumatic disease constitutes a risk factor. Moreover, the accuracy of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score for predicting outcome in this group of patients has been questioned. The primary goal of this study was to compare outcome of patients with rheumatic diseases admitted to a medical ICU to those of controls. The records of all patients admitted between 1 April 2003 and 30 June 2014 (n=4020) were screened for the presence of a rheumatic disease during admission (n=138). The diagnosis of a rheumatic disease was by standard criteria for these conditions. An age- and gender-matched control group of patients without a rheumatic disease was extracted from the patient population in the database during the same period (n=831). Mortality in ICU, in hospital and after 180 days did not differ significantly between patients with and without rheumatic diseases. There was no difference in the performance of the APACHE II score for predicting outcome in patients with rheumatic diseases and controls. This score, as well as a requirement for the use of inotropes or vasopressors, accurately predicted hospital mortality in the group of patients with rheumatic diseases. In conclusion, patients with a rheumatic condition admitted to intensive care do not do significantly worse than patients without such a disease.

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