Antimicrobial use in a critical care unit: a prospective observational study

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Pharmacology

Background:

• Antimicrobial resistance is a growing global health threat.
• Effective antimicrobial stewardship programs are crucial in intensive care units (ICUs) to optimize patient outcomes and reduce resistance.
• Understanding local antimicrobial utilization patterns is essential for developing targeted interventions.

Purpose of the Study:

• To characterize antimicrobial utilization, consumption, indications, and microbial resistance patterns.
• To identify specific targets for antimicrobial stewardship initiatives within a medical-surgical-trauma ICU.
• To establish a benchmark for antimicrobial use in this critical care setting.

Main Methods:

• A 30-day prospective observational study was conducted in a teaching hospital's medical-surgical-trauma ICU.
• Adult patients receiving antimicrobial therapy for at least 24 hours were enrolled.
• Data collected included antimicrobial class/agent use, consumption (DOT/1000PD), indications, prescriber, therapy modifications, and microbial resistance.

Main Results:

• Sixty-one patients received 133 antimicrobial courses, with piperacillin/tazobactam, cefazolin, and vancomycin being most frequent.
• Empirical therapy accounted for the majority of antimicrobial consumption (734.25 DOT/1000PD).
• Prolonged durations were observed for carbapenems and surgical prophylaxis, and suboptimal dosing was common.

Conclusions:

• Antimicrobial utilization and consumption were prospectively quantified, providing a valuable comparator for other ICUs.
• Key targets for antimicrobial stewardship include optimizing empirical therapy, treatment duration, dosing strategies, and route of administration.
• Addressing these areas can help mitigate antimicrobial resistance and improve patient care.