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Updated: Dec 23, 2025
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Inapropriate use of antibiotics effective against gram positive microorganisms despite restrictive antibiotic
Hasan Selçuk Özger1, Dolunay Merve Fakıoğlu2, Kübra Erbay1
1Faculty of Medicine, Department of Infectious Diseases, Gazi University, Ankara, Turkey.
Background:
Gram-positive spectrum antibiotics such as vancomycin, teicoplanin, daptomycin, and linezolid are frequently used in empirical treatment combinations in critically ill patients. Such inappropriate and unnecessary widespread use, leads to sub-optimal utilisation. However they are covered by the antibiotics restriction programme. This prospective observational study, evaluates gram-positive anti-bacterial utilisations in intensive care units (ICUs) with various evaluation criteria, to determine the frequency of inappropriate usage and the intervention targets required to ensure optimum use.
Methods:
This clinical study was conducted prospectively between 01.10.2018 and 01.10.2019 in the medical and surgical ICUs of Gazi University Faculty of Medicine Hospital, Turkey. The total bed capacity was 55. Patients older than 18 years and who were prescribed gram-positive spectrum antibiotics (vancomycin, teicoplanin, linezolid, and daptomycin) were included. Patients under this age or immunosuppressed patients (neutropenic,- HIV-infected patients with hematologic or solid organ malignancies) were not included in the study. During the study period, 200 treatments were evaluated in 169 patients. The demographic and clinical features of the patients were recorded. Besides observations by the clinical staff, the treatments were recorded and evaluated by two infectious diseases specialists and two clinical pharmacists at 24-h intervals from the first day to the last day of treatment. SPSS software for Windows, (version 17, IBM, Armonk, NY) was used to analyse the data. Categorical variables were presented as number and percentage, and non-categorical variables were presented as mean ± standard deviation.
Results:
It was found that inappropriate gram-positive antibiotic use in ICUs was as high as 83% in terms of non-compliance with the selected quality parameters. Multivariate analysis was performed to evaluate the factors associated with inappropriate antibiotic use, increased creatinine levels were found to increase the risk of such use.
Conclusions:
In spite of the restricted antibiotics programme, inappropriate antibiotic use in ICUs is quite common. Thus, it is necessary to establish local guidelines in collaboration with different disciplines for the determination and follow-up of de-escalation of such use and optimal treatment doses.
Insights
Despite antibiotic restrictions, 83% of gram-positive antibiotic use in intensive care units (ICUs) was inappropriate. Increased creatinine levels were linked to this overuse, highlighting the need for local guidelines to optimize antibiotic stewardship.
Area of Science:
- Clinical Pharmacy
- Infectious Diseases
- Critical Care Medicine
Background:
- Gram-positive antibiotics like vancomycin are crucial for critically ill patients.
- Widespread empirical use often leads to suboptimal antibiotic utilization.
- Existing antibiotic restriction programs aim to control usage.
Purpose of the Study:
- To prospectively evaluate gram-positive antibiotic utilization in intensive care units (ICUs).
- To determine the frequency of inappropriate antibiotic usage.
- To identify targets for intervention to ensure optimal antibiotic use.
Main Methods:
- Prospective observational study in medical and surgical ICUs from October 2018 to October 2019.
- Inclusion of adult patients receiving gram-positive antibiotics (vancomycin, teicoplanin, linezolid, daptomycin).
- Evaluation of 200 treatments in 169 patients by infectious diseases specialists and clinical pharmacists.
Main Results:
- A high rate of inappropriate gram-positive antibiotic use was observed, reaching 83%.
- Non-compliance with quality parameters was the primary indicator of inappropriate use.
- Elevated creatinine levels were identified as a factor associated with increased risk of inappropriate antibiotic use.
Conclusions:
- Inappropriate antibiotic use in ICUs remains common despite restriction programs.
- There is a critical need for establishing local guidelines involving multidisciplinary collaboration.
- Guidelines should focus on de-escalation strategies and optimizing antibiotic treatment doses.
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