A complete and multifaceted overview of antibiotic use and infection diagnosis in the intensive care unit: results from a prospective four-year registration

Abstract

BackgroundPreparing an antibiotic stewardship program requires detailed information on overall antibiotic use, prescription indication and ecology. However, longitudinal data of this kind are scarce. Computerization of the patient chart has offered the potential to collect complete data of high resolution. To gain insight in our global antibiotic use, we aimed to explore antibiotic prescription in our intensive care unit (ICU) from various angles over a prolonged time period.MethodsWe studied all adult patients admitted to Ghent University Hospital ICU from 1 January 2013 until 31 December 2016. Antibiotic prescription data were prospectively merged with diagnostic (suspected focus, severity and probability of infection at the time of prescription, or prophylaxis) and microbiology data by ICU physicians during daily workflow through dedicated software. Definite focus of infection and probability of infection (classified as high/moderate/low) were reassessed by dedicated ICU physicians at patient discharge.ResultsDuring the study period, 8763 patients were admitted and overall antibiotic consumption amounted to 1232 days of therapy (DOT)/1000 patient days. Antibacterial DOT (84% of total DOT) were linked with infection in 80%; the predominant foci were the respiratory tract (49%) and the abdomen (19%). A microbial cause was identified in 56% (3169/5686). Moderate/low probability infections accounted for 42% of antibacterial DOT prescribed for respiratory tract infections; for abdominal infections, this figure was 15%. The median treatment duration of moderate/low probability respiratory infections was 4 days (IQR 3–7). Antifungal DOT (16% of total DOT) were linked with infection in 47% of total antifungal DOT. Antifungal prophylaxis was primarily administered in the surgical ICU (76%), with a median duration of 4 DOT (IQR 2–9).ConclusionsBy prospectively combining antibiotic, microbiology and clinical data we were able to construct a longitudinal, multifaceted dataset on antibiotic use and infection diagnosis. A complete overview of this kind may allow the identification of antibiotic prescription patterns that require future antibiotic stewardship attention.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2178-7) contains supplementary material, which is available to authorized users.

Attributable Mortality of Ventilator-associated Pneumonia. Replicating Findings, Revisiting Methods

“…Given the multitude of potential sources of variation, past observational studies produced highly variable findings with excess risk estimates ranging from 0 up to 50% (5). Multi-state model (MSM) approaches for estimating mortality and prolonged stay due to HAIs have been widely advocated in recent years as they aid in avoiding common types of bias (5)(6)(7). Their focus on a specific effect measure, the time-dependent populationattributable fraction (PAF), may moreover reduce variability in findings due to various definitions of excess risk.…”

What every intensivist must know about antimicrobial stewardship: its pitfalls and its challenges

“…Recently, De Bus et al described the system used in the Ghent University Hospital ICU. ( 26 ) Antibiotic prescription data were prospectively merged with diagnostic and microbiology data by ICU physicians through dedicated software during a 4-year period. Definite focus of infection and probability of infection (high/moderate/low) were reassessed by dedicated ICU physicians at patient discharge.…”

Antibiotic prophylaxis in the ICU: to be or not to be administered for patients undergoing procedures?

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