# Analysis of Defined Daily Dose (DDD) and antibiotic problems in Intensive Care Unit (ICU) patients

## TL;DR

This study evaluates antibiotic use and drug-related problems in ICU patients to improve infection management and reduce antimicrobial resistance.

## Contribution

The study combines DDD and DRP analysis in ICU settings to support antimicrobial stewardship programs.

## Key findings

- Antibiotic consumption in ICU was 91.54 DDD/100 patient-days, with ceftriaxone being the most used.
- Unnecessary drug therapy and suboptimal therapeutic effects were the most frequent drug-related problems.

## Abstract

The increasing prevalence of antimicrobial resistance (AMR) in Intensive Care Unit (ICU) is posing a significant challenge to effective infection management. This shows the need for quantitative evaluation of antibiotic use through the Defined Daily Dose (DDD) method, combined with Drug Related Problems (DRPs) analysis to support Antimicrobial Stewardship (AMS) programs. Therefore, this study aimed to analyze the quantitative use of antibiotic using DDD method and identify DRP in ICU patients at Airlangga University Hospital. A retrospective cross-sectional study was conducted using medical records of ICU patients from July to December 2022. Antibiotic consumption was calculated in DDD per 100 patient-days following WHO standards, while DRPs were identified using the Cipolle and Pharmaceutical Care Network Europe (PCNE) v9.1 classifications. A total of 125 ICU patients met the inclusion criteria, with a predominance of pneumonia (40 %) and sepsis (25 %). The results showed that the total antibiotic consumption was 91.54 DDD/100 patient-days, with ceftriaxone having the highest (31.57 DDD/100 patient-days). The most frequent DRPs were unnecessary drug therapy (20 %) and suboptimal therapeutic effects (23 %), mainly due to inappropriate indications and deviations from treatment guidelines. Antibiotic use in ICU was dominated by ceftriaxone, and the high rate of DRPs showed the need for improved AMS. This study showed that strengthening interdisciplinary collaboration, regular audits, and adherence to clinical guidelines were essential steps to optimize antibiotic use and minimize the risk of resistance.