Antimicrobial usage in an intensive care unit: a prospective analysis

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Clinical Pharmacy

Background:

• Appropriate antimicrobial therapy selection and duration are crucial in Intensive Care Units (ICUs).
• Variations in antimicrobial use can impact patient outcomes and contribute to antimicrobial resistance.

Purpose of the Study:

• To prospectively analyze antimicrobial therapy use in a semi-closed ICU.
• To identify indications, agents, duration, and reasons for changes in antimicrobial therapy.
• To evaluate the appropriateness of surgical prophylaxis duration.

Main Methods:

• Prospective observational study over a three-month period.
• Recording of antimicrobial therapy indications, agents, duration, and changes.
• Analysis of 51 patient admissions and 135 therapy changes.

Main Results:

• All 51 admitted patients received antimicrobial therapy.
• 135 antimicrobial therapy changes occurred, primarily driven by clinical teams.
• Most changes were not culture-based (41% clinical response, 25% sensitivity results).
• 63% of prophylactic antibiotic courses exceeded 24 hours.

Conclusions:

• Antimicrobial therapy modifications in the ICU are frequently initiated without culture data.
• Surgical prophylaxis duration often surpasses established guidelines.
• There is a need for enhanced antimicrobial stewardship protocols in ICUs.