A prospective antibacterial utilization study in pediatric intensive care unit of a tertiary referral center

IntroductIonIncidence of infections in patients admitted to Pediatric Intensive Care Unit (PICU) is high due to the presence of critical illness and occurrence of nosocomial infections, which leads to higher use of antibacterial agents.[1][2][3][4] The inappropriate use of antibacterials causes emergence of antibacterial-resistant organisms, resulting in prolonged hospital stay, increased mortality and morbidity, high treatment costs, and increased burden on existing hospital resources.[5][6][7][8] Drug use studies are more essential in pediatric pharmacotherapy since one-third of the total prescriptions in children are systemic antibacterials such as vancomycin, colistin, meropenem, imipenem, and piperacillin-tazobactam. [9][10][11][12][13][14][15] A prospective drug usage study of antibacterials may serve as an important source of information for the assessment of prescription patterns and formulating future antibacterial usage policies.There is a lack of data on the antibacterial use from our PICU; therefore, the present study was conducted with the aim to evaluate the current prescribing pattern of vancomycin, colistin, meropenem, imipenem, and piperacillin-tazobactam along with other antibacterials and also to assess the antibacterial treatment cost. MaterIals and Methods EthicsThe study was initiated after obtaining the Institutional Ethics Committee (IEC) approval.Written informed consent was obtained from the parent and legal guardian of the patient.Purpose: Antibacterials are commonly prescribed to Pediatric Intensive Care Unit (PICU) patients.However, inappropriate antibacterial prescriptions lead to increases in antibacterial resistance, treatment cost, duration of treatment, and poor clinical outcome.The antibacterial utilization study assesses the prescription patterns and if necessary recommends the interventions to improve antibacterial prescriptions.Hence, the present prospective groundwork was conducted.Materials and Methods: The study was conducted over the period of 6 months (April 18 to October 20, 2014).The demographics and drug use details were captured daily from patients admitted to PICU to assess World Health Organization indicators.Results: A total of 200 patients enrolled, among them 119 males and 81 females.There were 12.46 (±6.16) drugs prescribed per patient, of which 2.38 (±1.48) were antibacterials.Among the total drug prescribed, 18.49% were antibacterials and 97% patients received at least one antibacterial.Ceftriaxone (49.48%) was the most commonly prescribed antibacterial, while imipenem (2.58%) and colistin (2.06%) use was very low.A total of 80.95% antibacterials were prescribed by generic name, 94.88% were administered intravenously, and 80.76% were prescribed from hospital pharmacy.The average length of PICU stay was 6.15 days (±6.20), the average length of antibacterial treatment was 6.08 days (±6.27), and the average length of empirical antibacterial treatment was 5.50 days (±5.40).The cost of antibacterial therapy per patient was Indian rupees 824.64 (±235.35).In 27 patients, bacterial culture test was positive and of whom 21 received antibacterials as per sensitivity pattern.Conclusions: The use of antibacterials was not indiscriminately high but more prescriptions per sensitivity pattern are required.