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

Authors

  • Eko Setiawan Center for Medicine Information and Pharmaceutical Care (CMIPC), Faculty of Pharmacy, Universitas Surabaya
  • Hidayat Felix Siloam Hospital Kebun Jeruk Jakarta
  • Adji Prayitno Setiadi Center for Medicine Information and Pharmaceutical Care (CMIPC), Faculty of Pharmacy, Universitas Surabaya

DOI:

https://doi.org/10.12928/pharmaciana.v7i2.6767

Keywords:

antibiotics, intensive care, resistance, antibiotic cost

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,-).

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.

Downloads

Published

2017-11-20

Issue

Vol. 7 No. 2 (2017): Pharmaciana

Section

Clinical and Community Pharmacy

License

Authors who publish with Pharmaciana agree to the following terms:

  1. Authors retain copyright and grant the journal the right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY-SA 4.0) that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal. 
  2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.