J Vallès1, S Fernández2, E Cortés2, A Morón3, E Fondevilla4, J C Oliva2, E Diaz2. 1. Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain. Electronic address: jvalles@tauli.cat. 2. Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain. 3. Department of Pharmacy, Hospital Universitari Parc Taulí, Sabadell, Spain. 4. Centre Coordinador del VINCat, Barcelona, Spain.
Abstract
OBJECTIVE: To compare the measurement of antimicrobial consumption by defined daily dose (DDD) versus by days of therapy (DOT). DESIGN: Retrospective analysis of clinical and administrative data from patients admitted to a polyvalent ICU. SETTING: ICU at a University Hospital in Spain. PATIENTS: All patients admitted to the ICU. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: For the DDD method, the World Health Organization (WHO)-assigned DDD was determined for the all the prescribed antimicrobials. For the DOT method, one DOT represented the administration of a single agent on a given day regardless of the number of doses administered. To express aggregate use, total DDDs and total DOTs were normalized to 100 patient-days. RESULTS: During the study period, 2393 adult patients were admitted to the ICU. Total median antimicrobial drugs measured by DDDs was 535.3 (IQR 319.8-845.5) vs. 344.0 (IQR 117.2-544.5) when measured by DOTs, p<0.001. When antimicrobial consumption was normalized to 100 patient-days, median antimicrobial consumption was also higher when measured by DDDs [2.98/100 patient-days (IQR 1.76-5.25) vs. 1.89/100 patient-days (IQR 0.64-3.0) when measured by DOTs, p<0.001]. CONCLUSIONS: For most antibacterial and antifungal drugs used in critically ill patients, estimates of aggregate antibiotic use by DDDs per 100 patient-days and DOTs per 100 patient-days are discordant because the administered dose is dissimilar from the WHO-assigned DDD. DOT methods should be recommended to avoid the overestimation that occurs with DDDs in adult critically ill patients.
OBJECTIVE: To compare the measurement of antimicrobial consumption by defined daily dose (DDD) versus by days of therapy (DOT). DESIGN: Retrospective analysis of clinical and administrative data from patients admitted to a polyvalent ICU. SETTING: ICU at a University Hospital in Spain. PATIENTS: All patients admitted to the ICU. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: For the DDD method, the World Health Organization (WHO)-assigned DDD was determined for the all the prescribed antimicrobials. For the DOT method, one DOT represented the administration of a single agent on a given day regardless of the number of doses administered. To express aggregate use, total DDDs and total DOTs were normalized to 100 patient-days. RESULTS: During the study period, 2393 adult patients were admitted to the ICU. Total median antimicrobial drugs measured by DDDs was 535.3 (IQR 319.8-845.5) vs. 344.0 (IQR 117.2-544.5) when measured by DOTs, p<0.001. When antimicrobial consumption was normalized to 100 patient-days, median antimicrobial consumption was also higher when measured by DDDs [2.98/100 patient-days (IQR 1.76-5.25) vs. 1.89/100 patient-days (IQR 0.64-3.0) when measured by DOTs, p<0.001]. CONCLUSIONS: For most antibacterial and antifungal drugs used in critically ill patients, estimates of aggregate antibiotic use by DDDs per 100 patient-days and DOTs per 100 patient-days are discordant because the administered dose is dissimilar from the WHO-assigned DDD. DOT methods should be recommended to avoid the overestimation that occurs with DDDs in adult critically ill patients.
Keywords:
Antimicrobial consumption; Consumo de antibióticos; Critically ill patients; Defined by days of therapy; Defined daily dose; Dosis diarias definidas; Dosis por días de tratamiento; Intensive care unit; Pacientes críticos; Unidad de cuidados intensivos
Authors: Gergő József Szőllősi; Klára Boruzs; Andrea Karcagi-Kováts; Nándor Kalas; Gábor Bányai; Klára Bíró Journal: Front Public Health Date: 2022-09-07
Authors: Patricia Helena Castro Nunes; Jessica Pronestino de Lima Moreira; Alessandra de Figueiredo Thompson; Thalita Lyrio da Silveira Machado; José Cerbino-Neto; Fernando Augusto Bozza Journal: Front Pharmacol Date: 2022-06-16 Impact factor: 5.988