Evaluation of antibiotic consumption in Intensive Care Units of a teaching hospital based on defined daily dose metrics and WHO Access, Watch, Reserve classification framework

Introduction: Antimicrobial resistance (AMR) represents a global public health crisis. The WHO Global Action Plan and India’s National Action Plan on AMR underscore the rational use of antibiotics in healthcare settings as a critical strategy for mitigating AMR. Intensive Care Units (ICUs) are high-risk environments for development of AMR. This study analyzes baseline antibiotic utilization data in ICUs by applying the defined daily dose (DDD) metrics in the context of the ‘Access’, ‘Watch’, ‘Reserve’ (AWaRe) classification framework. Materials and Methods: This prospective observational study was conducted over a 12-month period. Data from patients prescribed antibacterials for systemic use during their stay in the medicine, surgery, and neurosurgery ICUs were included. Antibiotic utilization was analyzed using daily dose metrics and the WHO AWaRe framework. Results: Data from 359 eligible ICU patients were analyzed. The DU75% segment included ‘Watch’ category antibiotics, ceftriaxone, meropenem, and ‘Access’ category antibiotics, metronidazole and doxycycline. ‘Watch’ category antibiotics were used most frequently, with a cumulative DDD/100 patient days of 71.8. This was followed by the ‘Access’ category with a cumulative DDD/100 patient days of 48. The use of ‘Watch’ category antibiotics in the NSICU was significantly higher than in other ICUs ( P < 0.005, χ 2 = 7.8). Antibiotics were used mostly for prophylaxis (59%), followed by empirical (28.4%) and definitive therapy (13%). Conclusions: The study demonstrates excessive use of ‘Watch’ antibiotics and a relative underuse of ‘Access’ agents in ICUs, emphasizing the scope for implementing robust stewardship measures including culture-guided de-escalation, formulary restriction of broad-spectrum agents, and implementing stringent surgical prophylaxis protocols.