Analysis of the utilization and cost of antibiotics at an intensive care unit in Surabaya

Eko Setiawan, Hidayat Felix, Adji Prayitno Setiadi

Abstract


The appropriateness of antibiotic utilization including the compatibility when it was mixed with other pharmaceutical products are important factors determining the effectiveness and cost of antibiotics treatment among patients admitted to the intensive care unit (ICU). The aim of this research was to figure out the antibiotics utilization, appropriateness, cost, and compatibility profile given to the inpatients of the intensive care unit in one hospital in Surabaya during November-December 2015. This research was prospective observational study using medical records as source of information. All patients’ data receiving antibiotics that met the inclusion and exclusion criteria was collected and analyzed descriptively. There were 42 patients participated in this research. Analysis of antibiotic utilization profile revealed 46 usage (65.71%) of single antibiotics and 24 usage (34.29%) of combination antibiotics. The most frequently used of antibiotic in single usage was ceftriaxone (43.48%) while in combination were ceftazidime and levofloxacin (12.50%). There were 30 antibiotics treatment changes that 43.34% was classified as escalation process and there was no (0%) any switching from intravenous to oral therapy. Only 4 out of 15 patients with infection related diagnosis (26.67%) got appropriate antibiotic treatment. Moreover, result from compatibility analysis found that 13.96% admixtures between antibiotics and other intravenous pharmaceutical products did not have clear compatibility status. The average of antibiotic cost per-patient was Rp. 459.492 (min-max: Rp 15.852,- to Rp 8.314.914,-).

Keywords


antibiotics, intensive care, resistance, antibiotic cost

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References


Adisasmito, A.W., & Tumbelaka, A.R., 2006, Penggunaan antibiotik khususnya pada infeksi bakteri gram negatif di ICU anak RSAB Harapan Kita, Sari Pediatri. 8(2):127-34.

Anggriani, Y., Banun, A., Erliana., 2013, Evaluasi penggunaan antibiotika di ruang HCU dan ruang ICU rumah sakit kanker “Dharmais†Februari-Maret 2012, Jurnal Ilmu Kefarmasian Indonesia. 11 (2):182-90.

Cucu, A., Nica, M., Ceausu, E., Cioran, N., 2014, Antimicrobial resistance profile in infectious disease hospital intensive care unit, FARMACIA. 62(4):767-76.

Dulhunty, J.M., Roberts, J.A., Davis, J.S., Webb, S.A., Bellomo, R., Gomersall, C., et al., 2013, Continuous infusion of beta-lactam antibiotics in severe sepsis: a multicenter double-blind, randomized controlled trial, Clin Infect Dis. 56(2):236-44.

Dwijayanti, S., Irawati, S., Setiawan, E., 2016, Profil kompatibilitas sediaan obat intravena dengan pelarut pada pasien intensive care unit, Jurnal Farmasi Klinik Indonesia. 5(2): 84-97.

Eachempati, S.R., Hydo, L.J., Shou, J., Barie, P.S., 2009, Does de-escalation of antibiotic therapy for ventilator-associated pneumonia affect the likelihood of recurrent pneumonia or mortality in critically ill surgical patients?, J Trauma. 66(5):1343-8.

Garnacho-Montero, J., Gutiérrez-Pizarraya, A., Escoresca-Ortega, A., Corcia-Palomo, Y., Fernández-Delgado, E., Herrera-Melero, I., et al., 2014, De-escalation of empirical therapy is associated with lower mortality in patients with severe sepsis and septic shock, Intensive Care Med. 40(1):32-40.

Goncalves-Pereira, J., & Povoa, P., 2011, Antibiotics in critically ill patients: a systematic review of the pharmacokinetics of β-lactams. Crit Care. 15(5):R206.

Gonzalez, L., Cravoisy, A., Barraud, D., Conrad, M., Nace, L., Lemarié, J., et al., 2013, Factors influencing the implementation of antibiotic de-escalation and impact of this strategy in critically ill patiens, Crit Care. 17(4):R140.

Hanberger, H., Walther, S., Leone, M., Barie, P.S., Rello, J., Lipman, J., et al., 2011, Increased mortality associated with methicillin-resistant Staphylococcus aureus (MRSA) infection in the intensive care unit: result from The EPIC II study, Int J Antimicrob Agents. 38(4):331-5.

Heenen, S., Jacobs, F., Vincent, J.L., 2012, Antibiotic strategies in severe nosocomial sepsis: why do we not de-escalate more often?, Crit Care Med. 40(5):1404-9.

Khan, R.A., Bakry, M.M., Islahudin, F., 2015, Appropriate antibiotic administration in critically ill patients with pneumonia, Indian J Pharm Sci. (3): 299-305.

Luciana, Andrajati, R., Rianti, A., Khan, A.H., 2015, Rational antimicrobial use in an intensive care unit in Jakarta, Indonesia: a hospital-based, cross-sectional study, Trop J Pharm Res. 14(4):707-14.

Marcon, A.P., Gamba, M.A., Vianna, L.A., 2006, Nosocomial diarrhea in the intensive care unit, Braz J Infect Dis. 10(6):384-9.

Marquet, K., Liesenborgs, A., Bergs, J., Vleugels, A., Claes, N., 2015, Incidence and outcome of inappropriate in-hospital empiric antibiotics for severe infection: a systematic review and meta-analysis, Crit Care. 19:63.

McKinnon, P.S., Paladino, J.A., Schentag, J.J., 2008, Evaluation of area under the inhibitory curve (AUIC) and time above the minimum inhibitory concentration (T>MIC) as predictors of outcome for cefepime and ceftazidime in serious bacterial infections, Int J Antimicrob Agents. 31(4):345-51.

Owens, R.C. Jr., Donskey, C.J., Gaynes, R.P., Loo, V.G., Muto, C.A., 2008, Antimicrobial-associated risk factors for Clostridium defficile, Clin Infect Dis. 46 Suppl 1:S19-31.

Paul, M., Kariv, G., Goldberg, E., Raskin, M., Shaked, H., Hazzan, R., et al., 2010, Importance of appropriate empirical antibiotic therapy for methicillin-resistant Staphylococcus aureus bacteraemia, J Antimicrob Chemother. 65(12):2658-65.

Roberts, J.A., & Lipman, J., 2009, Pharmacokinetic issues for antibiotics in the critically ill patient, Crit Care Med. 37(3):840-51.

Rubio-Terres, C., Garau, J., Grau, S., Martinez-Martinez, L., 2010, Cost of bacteraemia caused by methicillin-resistant vs. methicillin-susceptible Staphylococcus aureus in Spain: a retrospective cohort study, Clin Microbiol Infect. 16(6): 722-8.

Talpaert, M.J., Gopal Rao, G., Cooper, B.S., Wade, P., 2011, Impact of guidelines and enhanced antibiotic stewardship on reducing broad-spectrum antibiotic usage and its effect on incidence of Clostridium difficile infection, J Antimicrob Chemother. 66(9):2168-74.

Trissel, L.A., 2013, Handbook on injectable drugs, 17th edition. Bethesda: American Society of Health-System Pharmacists.

Williams, D.J., Hall, M., Shah, S.S., Parikh, K., Tyler, A., Neuman, M.I., et al., 2013, Narrow vs broad-spectrum antimicrobial therapy for children hospitalized with pneumonia, Pediatrics. 132(5): e1141–e1148.

Zilberberg, M.D., Shorr, A.F., Micek, S.T., Mody, S.H., Kollef, M.H., 2008, Antimicrobial therapy escalation and hospital mortality among patients with health-care-associated pneumonia: a single-center experience, Chest. 134(5):963-8.




DOI: http://dx.doi.org/10.12928/pharmaciana.v7i2.6767

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