Variation in antibiotic use across intensive care units (ICU): A population-based cohort study in Ontario, Canada

Abstract

Objectives: Antibiotics are commonly used in intensive care units (ICUs), yet differences in antibiotic use across ICUs are unknown. Herein, we studied antibiotic use across ICUs and examined factors that contributed to variation. Methods: We conducted a retrospective cohort study using data from Ontario’s Critical Care Information System (CCIS), which included 201 adult ICUs and 2,013,397 patient days from January 2012 to June 2016. Antibiotic use was measured in days of therapy (DOT) per 1,000 patient days. ICU factors included ability to provide ventilator support (level 3) or not (level 2), ICU type (medical-surgical or other), and academic status. Patient factors included severity of illness using multiple-organ dysfunction score (MODS), ventilatory support, and central venous catheter (CVC) use. We analyzed the effect of these factors on variation in antibiotic use. Results: Overall, 269,351 patients (56%) received antibiotics during their ICU stay. The mean antibiotic use was 624 (range 3–1460) DOT per 1,000 patient days. Antibiotic use was significantly higher in medical-surgical ICUs compared to other ICUs (697 vs 410 DOT per 1,000 patient days; P < .0001) and in level 3 ICUs compared to level 2 ICUs (751 vs 513 DOT per 1,000 patient days; P < .0001). Higher antibiotic use was associated with higher severity of illness and intensity of treatment. ICU and patient factors explained 47% of the variation in antibiotic use across ICUs. Conclusions: Antibiotic use varies widely across ICUs, which is partially associated with ICUs and patient characteristics. These differences highlight the importance of antimicrobial stewardship to ensure appropriate use of antibiotics in ICU patients.

Use of antimicrobials in the intensive care unit of a Loreto public hospital

“…El grupo etario de 30 a 59 años es el que recibe con mayor frecuencia prescripción antibiótica. Encontrándose similitudes con otro estudio (11) , donde los pacientes tenían 41,1 años como promedio de edad, siendo sus grupos más frecuentes los pacientes mayores entre 45 a 59 años de edad. En primera instancia, nos fijamos que las proporciones tanto de grupos como de media de edad son muy similares entre ambos estudios.…”

“…De manera muy similar a otros estudios, las indicaciones más frecuentes de antibióticos incluyen shock séptico, heridas quirúrgicas y neumonía. En un estudio (11) , las indicaciones incluyen shock séptico, profilaxis médico-quirúrgica, heridas quirúrgicas y neumonía. En otro estudio (16) , las indicaciones con mayor frecuencia fueron sepsis respiratoria, infección del tracto urinario e infección abdominal.…”

Antimicrobial stewardship

“…By measuring these factors longitudinally (i.e., over time in the same setting), changes in local epidemiology and prescribing habits may be detected. The external benchmarking of surveillance data offers additional information to better understand local practices and identify starting points for intervention [18,19].…”