Background: Antimicrobial stewardship (AMS) programs are increasingly implemented in intensive care units (ICU) to combat the emerging threat of antimicrobial-resistance. To optimise AMS programs, interventions need to be tailored to target problem areas. Aim: To provide an overview of the current antimicrobial prescribing patterns in a 32-bed ICU and thereby identify areas requiring improvement. Method: A 10-week prospective observational audit was conducted in the ICU of a public tertiary hospital. Patients on antimicrobial treatment or surgical prophylaxis antibiotics were audited. The primary outcomes were: duration of surgical antibiotic prophylaxis; duration of therapy for pneumonia, urosepsis and peritonitis; de-escalation within 24-h of microbiological results returning for empirical therapy; appropriate prescribing in penicillin allergy. Adherence to guidelines was also assessed. Results: A total of 277 cases were included. The mean duration of surgical antibiotic prophylaxis and adherence to maximum guideline duration were: cardiothoracic 21.6 h (83.9% adherence), vascular 14.9 h (81.8%), neurosurgery 20.4 h (40.0%) and general surgery 11.1 h (79.6%). The mean duration of therapy was 8.8 AE 4.7 days (62.5% adherence) for community-acquired pneumonia, 8.5 AE 4.6 days (28.6%) for hospital-acquired pneumonia and 11.9 AE 4.6 days (46.2%) for ventilator-associated pneumonia. Urosepsis and peritonitis were underpowered and complex. De-escalation occurred 63.2% of the time, with 75% occurring within 24-h of microbiological result availability. Antibiotic selection in 68.0% of patients with a documented penicillin allergy was appropriate. Conclusion: This study successfully identified baseline prescribing patterns and areas requiring improvement. With this information, tailored stewardship programs can be developed to improve antimicrobial utilisation in the critical care setting.
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