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JAC Advance Access published online on June 9, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh299
© 2004 by The British Society for Antimicrobial Chemotherapy
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Received October 31, 2003
Revised April 22, 2004
Accepted April 27, 2004

Brief report

Antibiotic usage in intensive care units: a pharmaco-epidemiological multicentre study

Paolo Malacarne 1, Carlotta Rossi 2, Guido Bertolini 2*, for the GiViTI group {dagger}

1 UO Anestesia e Rianimazione, Azienda Ospedaliera Pisana, Pisa, Italy
2 GiViTI Coordinating Centre, Istituto di Ricerche Farmacologiche ‘Mario Negri’: Centro di Ricerche Cliniche per le Malattie Rare Aldo e Cele Daccò, 24020 Ranica (Bergamo), Italy

* To whom correspondence should be addressed. E-mail: giviti{at}marionegri.it.


  Abstract

Objectives: To prospectively assess the use of antibiotics in ICUs.

Patients and methods: A total of 979 critically ill patients over 14 years of age were recruited in 43 Italian ICUs. For each patient, admission and discharge characteristics, information on the drugs administered, use of antibiotic susceptibility tests (ASTs), presence and severity of sepsis were collected daily until discharge or for a maximum of 21 days.

Results: Most patients with sepsis (99%) received antibiotics, and in almost all (93%) the treatment was started empirically, with broad-spectrum antibiotics. ASTs followed the onset of empirical treatment in 93% of cases. De-escalation was carried out in 16 patients, while in 37.6% of cases an antibiotic had to be changed or added. Antibiotic prophylaxis in surgical patients involved widespread use of drug combinations (31% of cases) and lasted 3 days on average. In non-surgical patients antibiotic prophylaxis lasted 4.6 days and in 42% a third-generation cephalosporin was used.

Conclusions: We found an appropriate approach to the therapeutic use of antibiotics: early empirical onset with broad-spectrum antimicrobial, followed by ASTs in order to target the therapy. However, in more than one-third of the cases the first-line choice was inappropriate. As regards prophylaxis, both surgical and non-surgical patients tended to have excessive duration of treatment, with widespread use of antibiotic combinations, too often involving a third-generation cephalosporin or carbapenem. This indicates a wide gap between clinical guidelines and clinical practice that calls for close assessment.

Key Words: Keywords: antibiotic use, critical care, prophylaxis, prospective study

{dagger}The complete list of study participants is given in the Acknowledgements.


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