A survey on infection management practices in Italian ICUs

• Published in: Critical care (London, England) England), 2012-11, Vol.16 (6), p.R221-R221, Article R221
• Main Authors: Bassetti, Matteo, De Gaudio, Raffaele, Mazzei, Teresita, Morace, Giulia, Petrosillo, Nicola, Viale, Pierluigi, Bello, Giuseppe, La Face, Sofia, Antonelli, Massimo
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Anti-Infective Agents - administration & dosage; Anti-Infective Agents - therapeutic use; Antibacterial agents; Antifungal agents; Antifungal Agents - administration & dosage; Antifungal Agents - therapeutic use; Bacterial Infections - diagnosis; Bacterial Infections - drug therapy; Critical care medicine; Cross Infection - diagnosis; Cross Infection - drug therapy; Cross Infection - prevention & control; Drug Administration Schedule; Evidence-based medicine; France; Health aspects; Health Care Surveys; Hospitals; Humans; Infection; Infection - diagnosis; Infection - drug therapy; Infection control; Infection Control - methods; Intensive Care Units - organization & administration; Intensive Care Units - statistics & numerical data; Italy; Italy - epidemiology; Japan; Management; Management techniques; Methicillin-Resistant Staphylococcus aureus; Mycoses; Mycoses - diagnosis; Mycoses - drug therapy; Pharmaceutical industry; Staphylococcal Infections - diagnosis; Staphylococcal Infections - drug therapy; Surveys; Surveys and Questionnaires; United States
• ISSN: 1364-8535; 1466-609X; 1364-8535
• DOI: 10.1186/cc11866

An online survey was conducted to characterize current infection management practices in Italian intensive care units (ICUs), including the antibacterial and antifungal drug regimens prescribed for various types of infections. During February and March 2011, all 450 ICUs in public hospitals in Italy were invited to take part in an online survey. The questionnaire focused on ICU characteristics, methods used to prevent, diagnose, and treat infections, and antimicrobials prescribing policies. The frequency of each reported practice was calculated as a percentage of the total number of units answering the question. The overall response rate to the questionnaire was 38.8% (175 of the 450 ICUs contacted) with homogeneous distribution across the country and in terms of unit type. Eighty-eight percent of the responding facilities performed periodical surveillance cultures on all patients. In 71% of patients, cultures were also collected on admission. Endotracheal/bronchial aspirates were the most frequently cultured specimens at both time points. Two-thirds of the responding units had never performed screening cultures for methicillin-resistant Staphylococcus aureus. Around 67% of the ICUs reported the use of antimicrobial de-escalation strategies during the treatment phase. In general, the use of empirical antimicrobial drug regimens was appropriate. Although the rationale for the choice was not always clearly documented, the use of a combination therapy was preferred over antibiotic monotherapy. The preferred first-line agents for invasive candidiasis were fluconazole and an echinocandin (64% and 25%, respectively). Two-thirds of the ICUs monitored vancomycin serum levels and administered it by continuous infusion in 86% of cases. For certain antibiotics, reported doses were too low to ensure effective treatment of severe infections in critically ill patients; conversely, inappropriately high doses were administered for certain antifungal drugs. Although infection control policies and management practices are generally appropriate in Italian ICUs, certain aspects, such as the extensive use of multidrug empirical regimens and the inappropriate antimicrobial dosing, deserve careful management and closer investigation.