OBJECTIVE: To evaluate antibiotic prescribing practices in empirical and directed treatment of severe sepsis and septic shock in Australian and New Zealand intensive care units. DESIGN, SETTING AND PARTICIPANTS: Case vignette survey of intended antibiotic prescribing for ICU patients with sepsis associated with community-acquired pneumonia (CAP), intra-abdominal infection (IAI), hospital-acquired pneumonia (HAP) or an unidentified infectious cause (UIC). Eighty-four specialists and advanced trainees working in an ICU setting in Australia and New Zealand responded to a questionnaire survey conducted between February and May 2009. MAIN OUTCOME MEASURES: Empirical and directed antibiotic therapy, including mode of administration, frequency of administration, dose and duration of therapy. RESULTS: A total of 656 antibiotics were empirically "prescribed", including 25 unique antibiotics. Combination therapy was prescribed in 82% of cases, with dual cover for CAP and triple therapy for IAI most common. Directed single-agent cover for Pseudomonas aeruginosa in HAP and flucloxacillin monotherapy for methicillin-sensitive Staphylococcus aureus bacteraemia were prescribed in 65% and 51% of cases, respectively. Supportive gentamicin therapy was commonly recommended (32% of all cases), predominantly in the form of once-daily dosing. Daily gentamicin dosage varied from 3 to 7mg/kg (excluding one outlier), and was largely compliant with recommendations (76% of doses being ≥5 mg/kg). Main areas of noncompliance with guidelines were provision of broader cover for resistant organisms and Β-lactam underdosing. Continuous and extended infusions were uncommon (5%). CONCLUSIONS: Antibiotic prescribing was largely appropriate, but consideration of site-specific resistance profiles and avoidance of low dosing is advocated to provide appropriate upfront cover, prevent underdosing and reduce the risk of developing resistant organisms.
OBJECTIVE: To evaluate antibiotic prescribing practices in empirical and directed treatment of severe sepsis and septic shock in Australian and New Zealand intensive care units. DESIGN, SETTING AND PARTICIPANTS: Case vignette survey of intended antibiotic prescribing for ICU patients with sepsis associated with community-acquired pneumonia (CAP), intra-abdominal infection (IAI), hospital-acquired pneumonia (HAP) or an unidentified infectious cause (UIC). Eighty-four specialists and advanced trainees working in an ICU setting in Australia and New Zealand responded to a questionnaire survey conducted between February and May 2009. MAIN OUTCOME MEASURES: Empirical and directed antibiotic therapy, including mode of administration, frequency of administration, dose and duration of therapy. RESULTS: A total of 656 antibiotics were empirically "prescribed", including 25 unique antibiotics. Combination therapy was prescribed in 82% of cases, with dual cover for CAP and triple therapy for IAI most common. Directed single-agent cover for Pseudomonas aeruginosa in HAP and flucloxacillin monotherapy for methicillin-sensitive Staphylococcus aureus bacteraemia were prescribed in 65% and 51% of cases, respectively. Supportive gentamicin therapy was commonly recommended (32% of all cases), predominantly in the form of once-daily dosing. Daily gentamicin dosage varied from 3 to 7mg/kg (excluding one outlier), and was largely compliant with recommendations (76% of doses being ≥5 mg/kg). Main areas of noncompliance with guidelines were provision of broader cover for resistant organisms and Β-lactam underdosing. Continuous and extended infusions were uncommon (5%). CONCLUSIONS: Antibiotic prescribing was largely appropriate, but consideration of site-specific resistance profiles and avoidance of low dosing is advocated to provide appropriate upfront cover, prevent underdosing and reduce the risk of developing resistant organisms.
Authors: Mohd H Abdul-Aziz; Joel M Dulhunty; Rinaldo Bellomo; Jeffrey Lipman; Jason A Roberts Journal: Ann Intensive Care Date: 2012-08-16 Impact factor: 6.925
Authors: Muhammad Azrai Rozali; Norny Syafinaz Abd Rahman; Helmi Sulaiman; Azrin Nurul Abd Rahman; Nadia Atiya; Wan Rahiza Wan Mat; Mohd Fadhil Jamaluddin; Muhd Zulfakar Mazlan; Mohd Basri Mat Nor; Mohd Shahnaz Hasan; Mohd Hafiz Abdul-Aziz Journal: J Pharm Bioallied Sci Date: 2020-11-05
Authors: Inge Spronk; Birgit C P Koch; Tim M J Ewoldt; Alan Abdulla; Puck van den Broek; Nicole Hunfeld; Soma Bahmany; Anouk E Muller; Diederik Gommers; Suzanne Polinder; Henrik Endeman Journal: BMC Infect Dis Date: 2022-07-13 Impact factor: 3.667