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Updated: Aug 26, 2026
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Cost and morbidity associated with antibiotic prophylaxis in the ICU
1Department of Surgery, University of Miami School of Medicine, FL 33101, USA.
Background:
Although the high cost and inappropriate use of antibiotics have been documented before, we are not aware of any data on nonsurgical site infectious morbidity associated with prolonged courses of prophylactic antibiotics (PA).
Study Design:
Data regarding antibiotic orders were collected using a custom designed microbiology database in the Surgical Intensive Care Unit of a teaching hospital from October 1, 1995 through April 30, 1997. The database was retrospectively reviewed. The cost of PA in excess of 1 day was calculated. Frequency of bacteremia and line infections were compared in patients receiving 1 day or less of PA versus more than 4 days of PA.
Results:
Sixty-one percent of PA orders were continued for more than 1 day. Cost of PA beyond 1 day totaled $44,893. Bacteremia and line infection were more frequent in the patients receiving more than 4 days of PA.
Conclusions:
There was poor compliance with the protocol of stopping PA at 24 hours. The cost of noncompliance was $44,893. There were more bacteremias and line infections in patients with duration of PA of more than 4 days.
Insights
Prolonged prophylactic antibiotic (PA) use beyond 24 hours is common and costly. Extended PA courses (over 4 days) were linked to increased rates of bacteremia and line infections in surgical patients.
Area of Science:
- Infectious Diseases
- Hospital Pharmacy
- Surgical Critical Care
Background:
- High costs and misuse of antibiotics are known issues.
- Data on infectious morbidity from prolonged prophylactic antibiotics (PA) were previously lacking.
Purpose of the Study:
- To investigate the association between prolonged prophylactic antibiotic use and infectious morbidity.
- To quantify the cost implications of non-compliance with short-course PA protocols.
Main Methods:
- Retrospective review of antibiotic orders from a Surgical Intensive Care Unit microbiology database (1995-1997).
- Calculation of costs associated with PA exceeding 1 day.
- Comparison of bacteremia and line infection rates between patients receiving ≤1 day vs. >4 days of PA.
Main Results:
- 61% of PA orders were continued beyond 1 day.
- The cost of PA beyond 1 day was $44,893.
- Higher frequencies of bacteremia and line infections were observed in patients receiving >4 days of PA.
Conclusions:
- Poor adherence to 24-hour PA protocols was identified.
- Non-compliance incurred significant costs ($44,893).
- Prolonged PA (>4 days) correlated with increased rates of bacteremia and line infections.
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