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Updated: May 21, 2026
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Does high antibiotic consumption still reflect bad practices?
T Levent1, F Delfosse, F Lambiotte
1Équipe opérationnelle en hygiène, Référent antibiotique, Centre hospitalier de Sambre-Avesnois, boulevard Pasteur, 59600 Maubeuge, France. t levent@ch-sa.com
Objective:
The authors had for aim to assess the quality of antibiotic prescription in an intensive care unit because of their high rate of consumption.
Design:
A prospective 5-month study was made of the first 50 prescriptions of ciprofloxacin, levofloxacin, teicoplanin, vancomycin, and imipenem. Treatment was considered adequate at day 5 if the indication was relevant, with the right doses, and if the prescription was adapted to the antibiogram.
Results:
Fifty treatments were evaluated (38 patients included). Eighty-four percent (42/50) was adequate at day 5. Glycopeptides and fluoroquinolones accounted for 2/3 of prescriptions. The absence of de-escalation was the most common mistake. The severity of presentations was evident with a mean SSI at 68 (22-113), and a mean BMI at 28 (18.5 - 50). Eighty-four percent (32/38) of patients were exposed to invasive devices, 47% died in the ICU.
Discussion:
Most prescriptions were adequate. The patient profile could explain the high rate of antibiotic consumption. Bacteriological monitoring revealed an increased prevalence of resistant bacteria, which could explain a high rate of consumption along with adaptation of the dose to overweight. De-escalation, using aminosides more frequently, and shorter prescribed courses of fluoroquinolones should improve consumption rates does not always reflect bad practices, but may be adequate when considering bacterial ecology and patient profile.
Insights
Antibiotic prescription quality in intensive care units (ICUs) was assessed, finding most prescriptions adequate despite high consumption. Patient factors and bacterial resistance influence antibiotic use, suggesting de-escalation and optimized dosing can improve rates.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Background:
- Intensive care units (ICUs) exhibit high antibiotic consumption rates.
- Assessing antibiotic prescription quality is crucial for optimizing patient outcomes and combating antimicrobial resistance.
Purpose of the Study:
- To evaluate the quality of antibiotic prescriptions in an ICU setting.
- To identify factors contributing to high antibiotic consumption.
Main Methods:
- A prospective study analyzed 50 prescriptions for specific antibiotics (ciprofloxacin, levofloxacin, teicoplanin, vancomycin, imipenem) over 5 months.
- Treatment adequacy was assessed on day 5 based on relevant indication, correct dosage, and antibiogram compatibility.
Main Results:
- Eighty-four percent (42/50) of antibiotic treatments were deemed adequate at day 5.
- Glycopeptides and fluoroquinolones comprised two-thirds of prescriptions.
- The most common error was the absence of de-escalation; patients were often severe, with high BMI and invasive device use, and 47% mortality.
Conclusions:
- While most prescriptions were adequate, patient profiles (severity, obesity) and bacterial resistance patterns contribute to high antibiotic consumption.
- Strategies like de-escalation, increased use of aminoglycosides, and shorter fluoroquinolone courses may improve antibiotic stewardship.
- Antibiotic use in ICUs requires careful consideration of bacterial ecology and individual patient needs.
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