Opportunities to Improve Antibiotic Appropriateness in U.S. ICUs: A Multicenter Evaluation.
Crit Care Med
; 48(7): 968-976, 2020 07.
Article
en En
| MEDLINE
| ID: mdl-32317600
ABSTRACT
OBJECTIVES:
To use a standardized tool for a multicenter assessment of antibiotic appropriateness in ICUs and identify local antibiotic stewardship improvement opportunities.DESIGN:
Pilot point prevalence conducted on October 5, 2016; point prevalence survey conducted on March 1, 2017.SETTING:
ICUs in 12 U.S. acute care hospitals with median bed size 563. PATIENTS Receiving antibiotics on participating units on March 1, 2017.INTERVENTIONS:
The Centers for Disease Control and Prevention tool for the Assessment of Appropriateness of Inpatient Antibiotics was made actionable by an expert antibiotic stewardship panel and implemented across hospitals. Data were collected by antibiotic stewardship program personnel at each hospital, deidentified and submitted in aggregate for benchmarking. hospital personnel identified most salient reasons for inappropriate use by category and agent. MEASUREMENTS AND MAINRESULTS:
Forty-seven ICUs participated. Most hospitals (83%) identified as teaching with median licensed ICU beds of 70. On March 1, 2017, 362 (54%) of 667 ICU patients were on antibiotics (range, 8-81 patients); of these, 112 (31%) were identified as inappropriate and administered greater than 72 hours among all 12 hospitals (range, 9-82%). Prophylactic antibiotic regimens and PICU patients demonstrated a statistically significant risk ratio of 1.76 and 1.90 for inappropriate treatment, respectively. Reasons for inappropriate use included unnecessarily broad spectrum (29%), no infection or nonbacterial syndrome (22%), and duration longer than necessary (21%). Of patients on inappropriate antibiotic therapy in surgical ICUs, a statistically significant risk ratio of 2.59 was calculated for noninfectious or nonbacterial reasons for inappropriate therapy.CONCLUSIONS:
In this multicenter point prevalence study, 31% of ICU antibiotic regimens were inappropriate; prophylactic regimens were often inappropriate across different ICU types, particularly in surgical ICUs. Engaging intensivists in antibiotic stewardship program efforts is crucial to sustain the efficacy of antibiotics and quality of infectious diseases care in critical care settings. This study underscores the value of standardized assessment tools and benchmarking to be shared with local leaders for targeted antibiotic stewardship program interventions.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Prescripción Inadecuada
/
Unidades de Cuidados Intensivos
/
Antibacterianos
Tipo de estudio:
Clinical_trials
/
Risk_factors_studies
Límite:
Humans
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Crit Care Med
Año:
2020
Tipo del documento:
Article
País de afiliación:
Canadá