A Multicenter Evaluation of Prolonged Empiric Antibiotic Therapy in Adult ICUs in the United States*

Abstract

Half of all empiric antibiotics ordered in critically ill patients are continued for at least 72 hours in absence of adjudicated infection. Additional studies are needed to confirm these findings and determine the risks and benefits of prolonged empiric therapy in the critically ill.

Neurotoxic Concentration of Piperacillin during Continuous Infusion in Critically Ill Patients

“…In combination with tazobactam as a ␤-lactamase inhibitor, it is among the most used broad-spectrum antibiotics in intensive care units (ICU) (1). Due to the variability of the pharmacokinetics (PK) in critically ill patients, therapeutic drug monitoring (TDM) of piperacillin is recommended in the ICU to adjust the dose according to the serum concentration (2).…”

A Multicenter, Prospective, Observational Study to Determine Predictive Factors for Multidrug‐Resistant Pneumonia in Critically Ill Adults: The DEFINE Study

“…However, many of these studies were limited due to single‐center and/or retrospective study designs. The concern for prescribing antimicrobial therapy that will not treat pneumonia caused by an MDRO has led to a corresponding increase in the use of broad‐spectrum antimicrobials . The HCAP categorization schema was intended to improve the utilization of appropriate, initial antimicrobial agents in patients suspected to be at greater risk of having a causative microorganism that is MDR.…”

“…The majority of existing research describing the epidemiology of pneumonia in critically ill patients in the United States comes from single‐center studies or retrospective analyses of third‐party payer databases, which either limit the generalizability of the results or lack patient‐specific data to develop specific conclusions and recommendations. Application of these data without consideration for their inherent limitations has contributed to overprescription of broad‐spectrum antimicrobial agents and prolonged empiric therapy without a concordant reduction in mortality . To our knowledge, there is no data from prospective, multicenter studies that define the epidemiology of pneumonia in critically ill patients in the United States.…”

Evaluation of the Use of Novel Biomarkers to Augment Antimicrobial Stewardship Program Activities

“…As the incidence of antimicrobial resistance increases in clinical settings, antimicrobial stewardship programs (ASPs) are focusing efforts on the appropriate diagnosis of infections and the subsequent use of antimicrobials. In many cases, clinical and diagnostic uncertainty of the origin or cause of infection leads to unnecessary antimicrobial prescribing or continuation . Furthermore, diagnostic uncertainty may result in missed opportunities to initiate therapy, resulting in delayed time to antimicrobial therapy and poor outcomes …”