Antimicrobial stewardship in intensive care: identifying areas for improvement

• Published in: Journal of pharmacy practice and research 2020-12, Vol.50 (6), p.490-497
• Main Authors: Maher, Dorsa, Larcombe, Rebecca, Potts, Simon D., Wiersema, Ubbo F.
• Format: Article
• Language: English
• Subjects: antibiotic; antibiotic resistance; antimicrobial stewardship; clinical audit; critical care; intensive care; surgical prophylaxis
• ISSN: 1445-937X; 2055-2335
• DOI: 10.1002/jppr.1667

Background Antimicrobial stewardship (AMS) programs are increasingly implemented in intensive care units (ICU) to combat the emerging threat of antimicrobial‐resistance. To optimise AMS programs, interventions need to be tailored to target problem areas. Aim To provide an overview of the current antimicrobial prescribing patterns in a 32‐bed ICU and thereby identify areas requiring improvement. Method A 10‐week prospective observational audit was conducted in the ICU of a public tertiary hospital. Patients on antimicrobial treatment or surgical prophylaxis antibiotics were audited. The primary outcomes were: duration of surgical antibiotic prophylaxis; duration of therapy for pneumonia, urosepsis and peritonitis; de‐escalation within 24‐h of microbiological results returning for empirical therapy; appropriate prescribing in penicillin allergy. Adherence to guidelines was also assessed. Results A total of 277 cases were included. The mean duration of surgical antibiotic prophylaxis and adherence to maximum guideline duration were: cardiothoracic 21.6 h (83.9% adherence), vascular 14.9 h (81.8%), neurosurgery 20.4 h (40.0%) and general surgery 11.1 h (79.6%). The mean duration of therapy was 8.8 ± 4.7 days (62.5% adherence) for community‐acquired pneumonia, 8.5 ± 4.6 days (28.6%) for hospital‐acquired pneumonia and 11.9 ± 4.6 days (46.2%) for ventilator‐associated pneumonia. Urosepsis and peritonitis were underpowered and complex. De‐escalation occurred 63.2% of the time, with 75% occurring within 24‐h of microbiological result availability. Antibiotic selection in 68.0% of patients with a documented penicillin allergy was appropriate. Conclusion This study successfully identified baseline prescribing patterns and areas requiring improvement. With this information, tailored stewardship programs can be developed to improve antimicrobial utilisation in the critical care setting.