Anaerobic antibiotic usage for pneumonia in the medical intensive care unit
Mutsumi J Kioka1, Bruno DiGiovine1, Mohamed Rezik1
1Division of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, Michigan, USA.
Background And Objective:
Pneumonia is a common admitting diagnosis in the intensive care unit (ICU). When aspiration is suspected, antibiotics to cover anaerobes are frequently used, but in the absence of clear risk factors, current guidelines have questioned their role. It is unknown how frequently these guidelines are followed.
Methods:
We conducted a single-centre observational study on practice patterns of anaerobic antibiotic use in consecutive patients admitted to the ICU with aspiration pneumonia (Asp), community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP).
Results:
A total of 192 patients were studied (Asp: 20, HCAP: 107, CAP: 65). Overall, 59 patients received anaerobic antibiotics (Asp: 90%, HCAP: 28%, CAP 17%) but a significant proportion of these patients did not meet criteria to receive them. Inappropriate anaerobic antibiotic use was 12/20 for Asp, 27/107 for HCAP and 9/65 for CAP. Mortality probability model III at zero hours (MPM0) score and a diagnosis of Asp were predictors of receiving inappropriate anaerobic antibiotics. Receiving inappropriate anaerobic antibiotics was associated with a longer ICU length of stay (LOS; 7 days (interquartile range (IQR): 7-21) vs 4 days (IQR:2-9), P = 0.017).
Conclusion:
For patients in the ICU admitted with pneumonia, there is a high occurrence of inappropriately prescribed anaerobic antibiotics, the use of which was associated with a longer ICU LOS.
Insights
Inappropriate use of anaerobic antibiotics for intensive care unit (ICU) pneumonia is common, particularly in aspiration pneumonia cases. This practice is linked to longer ICU stays.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Clinical Pharmacy
Background:
- Pneumonia is a frequent reason for intensive care unit (ICU) admission.
- Guidelines question the routine use of anaerobic antibiotics for pneumonia without clear aspiration risk factors.
- Current adherence to these guidelines in clinical practice is not well understood.
Purpose of the Study:
- To evaluate the practice patterns of anaerobic antibiotic prescribing in ICU patients with pneumonia.
- To determine the frequency of inappropriate anaerobic antibiotic use based on established criteria.
- To identify factors associated with inappropriate anaerobic antibiotic prescription and its impact on patient outcomes.
Main Methods:
- A single-center observational study was conducted.
- Consecutive patients admitted to the ICU with aspiration pneumonia (Asp), community-acquired pneumonia (CAP), and healthcare-associated pneumonia (HCAP) were included.
- Data on antibiotic use, patient characteristics, and outcomes were collected and analyzed.
Main Results:
- Out of 192 patients, 59 received anaerobic antibiotics. Inappropriate use was observed in 90% of Asp, 28% of HCAP, and 17% of CAP cases.
- Predictors for inappropriate anaerobic antibiotic use included a higher Mortality Probability Model III (MPM0) score and a diagnosis of aspiration pneumonia.
- Inappropriate anaerobic antibiotic use was significantly associated with a longer ICU length of stay (7 days vs. 4 days, P=0.017).
Conclusions:
- There is a high incidence of inappropriately prescribed anaerobic antibiotics for pneumonia in the ICU setting.
- The use of these antibiotics, when not indicated, is associated with prolonged ICU length of stay.
- Clinical practice may not align with current guidelines regarding anaerobic antibiotic use in pneumonia.
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