BACKGROUND: In intensive care unit (ICU) patients, signs of infection and inflammation are similar, making diagnosis of bacterial infections difficult. Antimicrobials may therefore be overused, contributing to development of antimicrobial-resistant bacteria. OBJECTIVES: To measure the accuracy of clinician decisions to start antimicrobials; to correlate clinician certainty with the presence of infection; and to examine whether physiological variables correlate with clinician certainty. DESIGN: Prospective observational study. SETTING AND PATIENTS: Patients staying >48 hours in a general ICU of a tertiary care hospital. MEASUREMENTS: The ICU clinician's certainty for the presence of infection was recorded when starting antimicrobials. An independent infectious diseases (ID) specialist determined if antimicrobials were required and if infection was present. Clinician antibiotic start decisions were tested for accuracy according to the ID determination for the presence of infection. RESULTS: Empirical antimicrobial therapy was justified by the presence of infection on 67/125 (54%) occasions. Clinician certainty for infection correlated well with the presence of defined infection (r(2) = 0.78), however, infection was defined on 6/19 (31%) occasions when ICU clinician certainty was low (≤2), and antimicrobials were prescribed even when clinician certainty was minimal. Antimicrobial course length was similar whether infection was defined or not (11.5 ± 9.2 vs 10.7 ± 9.1 days; P = 0.65). Physiological variables were not associated with clinician certainty of infection. CONCLUSIONS: Antimicrobial therapy is probably overused in the ICU, possibly resulting from difficulties in diagnosis and the perceived greater risk of untreated infection when compared to the risks of potentially unnecessary antimicrobial therapy. Efforts to improve antimicrobial-related decision-making should be mandatory.
BACKGROUND: In intensive care unit (ICU) patients, signs of infection and inflammation are similar, making diagnosis of bacterial infections difficult. Antimicrobials may therefore be overused, contributing to development of antimicrobial-resistant bacteria. OBJECTIVES: To measure the accuracy of clinician decisions to start antimicrobials; to correlate clinician certainty with the presence of infection; and to examine whether physiological variables correlate with clinician certainty. DESIGN: Prospective observational study. SETTING AND PATIENTS: Patients staying >48 hours in a general ICU of a tertiary care hospital. MEASUREMENTS: The ICU clinician's certainty for the presence of infection was recorded when starting antimicrobials. An independent infectious diseases (ID) specialist determined if antimicrobials were required and if infection was present. Clinician antibiotic start decisions were tested for accuracy according to the ID determination for the presence of infection. RESULTS: Empirical antimicrobial therapy was justified by the presence of infection on 67/125 (54%) occasions. Clinician certainty for infection correlated well with the presence of defined infection (r(2) = 0.78), however, infection was defined on 6/19 (31%) occasions when ICU clinician certainty was low (≤2), and antimicrobials were prescribed even when clinician certainty was minimal. Antimicrobial course length was similar whether infection was defined or not (11.5 ± 9.2 vs 10.7 ± 9.1 days; P = 0.65). Physiological variables were not associated with clinician certainty of infection. CONCLUSIONS: Antimicrobial therapy is probably overused in the ICU, possibly resulting from difficulties in diagnosis and the perceived greater risk of untreated infection when compared to the risks of potentially unnecessary antimicrobial therapy. Efforts to improve antimicrobial-related decision-making should be mandatory.
Authors: Ban Al-Sayyed; Jeremy Le; Mohammad Mousbah Al-Tabbaa; Brian Barnacle; Jinma Ren; Richard Tapping; Meenakshy Aiyer Journal: J Pediatr Pharmacol Ther Date: 2019 Jan-Feb
Authors: Erika M C D'Agata; Diana Tran; Josef Bautista; Douglas Shemin; Daniel Grima Journal: Clin J Am Soc Nephrol Date: 2018-08-23 Impact factor: 8.237
Authors: Laura Evans; Andrew Rhodes; Waleed Alhazzani; Massimo Antonelli; Craig M Coopersmith; Craig French; Flávia R Machado; Lauralyn Mcintyre; Marlies Ostermann; Hallie C Prescott; Christa Schorr; Steven Simpson; W Joost Wiersinga; Fayez Alshamsi; Derek C Angus; Yaseen Arabi; Luciano Azevedo; Richard Beale; Gregory Beilman; Emilie Belley-Cote; Lisa Burry; Maurizio Cecconi; John Centofanti; Angel Coz Yataco; Jan De Waele; R Phillip Dellinger; Kent Doi; Bin Du; Elisa Estenssoro; Ricard Ferrer; Charles Gomersall; Carol Hodgson; Morten Hylander Møller; Theodore Iwashyna; Shevin Jacob; Ruth Kleinpell; Michael Klompas; Younsuck Koh; Anand Kumar; Arthur Kwizera; Suzana Lobo; Henry Masur; Steven McGloughlin; Sangeeta Mehta; Yatin Mehta; Mervyn Mer; Mark Nunnally; Simon Oczkowski; Tiffany Osborn; Elizabeth Papathanassoglou; Anders Perner; Michael Puskarich; Jason Roberts; William Schweickert; Maureen Seckel; Jonathan Sevransky; Charles L Sprung; Tobias Welte; Janice Zimmerman; Mitchell Levy Journal: Intensive Care Med Date: 2021-10-02 Impact factor: 17.440
Authors: Nehad J Ahmad; Abdullah U Althemery; Abdul Haseeb; Reham F Yusuf; Azmi Ahmed Hassali; Amer H Khan Journal: J Pharm Bioallied Sci Date: 2020-01-29
Authors: Peter M C Klein Klouwenberg; Olaf L Cremer; Lonneke A van Vught; David S Y Ong; Jos F Frencken; Marcus J Schultz; Marc J Bonten; Tom van der Poll Journal: Crit Care Date: 2015-09-07 Impact factor: 9.097