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Antibiotic usage in intensive care units: a pharmaco-epidemiological multicentre study
Paolo Malacarne1, Carlotta Rossi, Guido Bertolini
1UO Anestesia e Rianimazione, Azienda Ospedaliera Pisana, Pisa, Italy.
The Journal of Antimicrobial Chemotherapy
|June 11, 2004
Summary
Antibiotic use in intensive care units (ICUs) often starts empirically with broad-spectrum agents, followed by antibiotic susceptibility tests (ASTs). However, prophylaxis duration and drug choices frequently deviate from guidelines, indicating a gap in clinical practice.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Background:
- Antibiotic stewardship is crucial in intensive care units (ICUs) to combat antimicrobial resistance.
- Understanding current antibiotic prescribing patterns is essential for improving patient outcomes.
Purpose of the Study:
- To prospectively evaluate antibiotic utilization in critically ill patients within Italian ICUs.
- To assess the alignment of antibiotic prescribing practices with established clinical guidelines.
Main Methods:
- A prospective study involving 979 critically ill patients (age >14) across 43 Italian ICUs.
- Data collection included patient characteristics, administered drugs, antibiotic susceptibility tests (ASTs), and sepsis severity.
- Information was gathered daily until discharge or for a maximum of 21 days.
Main Results:
- 99% of sepsis patients received antibiotics, with 93% initiated empirically using broad-spectrum agents.
- Antibiotic susceptibility tests (ASTs) were performed post-initiation in 93% of cases; de-escalation occurred in only 16 patients.
- Prophylaxis involved combination therapy in 31% of surgical patients and prolonged treatment durations in both surgical and non-surgical groups, often using third-generation cephalosporins or carbapenems.
Conclusions:
- While empirical broad-spectrum antibiotic use followed by ASTs reflects an appropriate therapeutic strategy, over one-third of initial choices were inappropriate.
- Antibiotic prophylaxis in ICUs, for both surgical and non-surgical patients, demonstrated excessive duration and frequent use of broad-spectrum combinations, deviating from guidelines.
- A significant discrepancy exists between recommended clinical guidelines and actual clinical practice in antibiotic use within ICUs, necessitating targeted interventions.