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MONITORING and QUALITY ASSURANCE of Antibiotic USAGE in INTENSIVE CARE UNIT

MONITORING and QUALITY ASSURANCE of Antibiotic USAGE in INTENSIVE CARE UNIT. Zunilda Djanun*, Rudyanto S**, Yulia Rosa***, *Dept. Clinical Pharmacology FMUI/CMH, **ICU CMH, *** Dept. Clinical Microbiology FMUI. Introduction.

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MONITORING and QUALITY ASSURANCE of Antibiotic USAGE in INTENSIVE CARE UNIT

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  1. MONITORING andQUALITY ASSURANCE of Antibiotic USAGE in INTENSIVE CARE UNIT Zunilda Djanun*, Rudyanto S**, Yulia Rosa***, *Dept. Clinical Pharmacology FMUI/CMH, **ICU CMH, *** Dept. Clinical Microbiology FMUI

  2. Introduction • Antibiotics is the most frequently misused drug: in the community and hospitals1,2 • Inapproriate use of AB is the most influencing factor in the emergence of antimicrobial resistance • High antibiotics consumption is associated with high prevalence of nosocomial infections in ICU • Nonadherence to empirical AB guidelines is associated with increased in-hospital mortality in ICU3 • Efforts being taken nationally: AM resistance control program in hospitals4

  3. AB audit in ICU CMH Methods • Prospective: January-February 2010 • Observation & patient’s chart • AB usage: • Indications: prophylaxis, empiric, definitive, not known • Choice of AB • Dosages, duration, time and route of administration Objectives Primary: to determine the quality of AB usage according to Gyssens’ criteria5 Secondary: to see antibiotic usage pattern and AM resistance pattern

  4. Gyssens’ category for quality of AB use5 0: Appropriate use of AM therapy/prophylaxis I: AM prescription is inappropriate due to improper timing II: AM prescription is inappropriate due to • Improper dosage (A), dosage interval (B), route (C) III: AM prescription is inappropriate due to • Excessive length of use (A) or duration to short (B) IV: AM prescription is inappropriate due to availability of • More effective alternative (A) • Less toxic alternative (B) • Less expensive alternative (C) • Narrower spectrum alternative (D) • V: AM prescription is unjustified • VI: information insufficient for categorization

  5. Indication of AB • Prophylaxis: for appropriate case and given within 60 minutes before incision • Empiric: given before ICU or in ICU for suspected infection • Definitive: given according to microbiological result (streamlining) • Not known (NK): • Given without any suspected infection • Given preoperatively for improper case • Given postoperatively but different from the prophylaxis • Given in the ICU without any AB prior to surgery

  6. Results Reasons for AB: Medical vs. surgical 165 patients: 134 surgical & 31 medical 5 out of 134 are not received AB 26 AB - J01 (OAT & antifungal are excluded) 254 usages with 1-12 days duration (surgical) 1-14 days duration (medical)

  7. Quality according to Gyssens Jan-Feb, 2010

  8. Quality 2010 vs. 2009 Ceftriaxone Ceftazidime Meropenem Ceftazidime Meropenem 2010 2009 2010 2009 2010 2009 2010 2009 2010 2009 I II III IV V

  9. Quality according to Gyssens (Jan-Febr)

  10. No. of microbial isolates (Jan-Feb)

  11. Antimicrobial resistance pattern (% sensitivity)

  12. Summary Conclussion The quality of AM use in ICU CMH was improved probably due to feedback and interventions that have been made • Judging quality of AM prescribing using Gyssens criteria is a complicated and time consuming work • It should include an infectious disease physician and use of STG • Weakness: data only from ICU  judgement on duration may be biased • Improvement: - reduced use of meropenem - shorter prophylaxis

  13. Policy implication Microbial specimen should be collected prior to initiation of an AM therapy in ICU AM therapy is reviewed in the morning parade List of AM with dosage recommendation is made available at bed side Screening for MRSA is routine measures for patients with AM therapy before admission AM audit results should be discussed with the surgery department AM audit will include the quantity and economic analysis

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