Antimicrobial Agent’s Utilization and Cost Pattern in Medical Intensive Care Unit of a Tertiary Care Hospital

Abstract

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.