Critical Analysis of Empiric Antibiotic Utilization: Establishing Benchmarks

Abstract

Aim: We critically evaluated empiric antibiotic practice in the surgical and trauma intensive care unit (STICU) with three specific objectives: (1) To characterize empiric antibiotics practice prospectively; (2) to determine how frequently STICU patients started on empiric antibiotics subsequently have a confirmed infection; and (3) to elucidate the complications associated with unnecessary empiric antibiotic therapy. Methods: We collected data prospectively using the Surgical Intensive Care-Infection Registry (SIC-IR) including all 1,185 patients admitted to the STICU for >2 days from March 2007 through May 2008. Empiric antibiotics were defined as those initiated because of suspected infections. Results: The mean patient age was 56 years and 62% were male. The mean STICU length of stay was eight days, and the mortality rate was 4.6%. Empiric antibiotics were started for 26.3% of the patients. The average length of antibiotic use was three days. Of the 312 patients started on empiric antibiotics, only 25.6% were found to have an infection. Factors associated with correctly starting empiric antibiotics were a longer STICU stay (5 vs. 3 days), prior antibiotics (29% vs. 17%), and mechanical ventilation (93% vs. 79%). Patients who were started on antibiotics without a subsequent confirmed infection were compared with patients not given empiric antibiotics. Incorrect use of empiric antibiotics was associated with younger age (p < 0.001), more STICU days (10.6 vs. 5.9 days; p < 0.001), more ventilator days (p < 0.001), more development of acute renal failure (24.1% vs. 12.1%; p < 0.001), and a significant difference in mortality rate (8.6% vs. 3.2%; p < 0.001). Conclusions: After admission to the STICU, 26% of patients received at least one course of empiric antibiotics. Only 25.6% of these patients were confirmed to have an infection. These results provide key benchmark data for the critical care community to improve antibiotic stewardship.

Antimicrobial use in a critical care unit: a prospective observational study

“…A prospective evaluation in a surgical and trauma ICU found that of 312 patients receiving empirical therapy only 25.6% were found to have an infection [14] . The empirical antibiotic group had a greater number of total antibiotic days, was more likely to develop a confirmed infection, and had more resistant organisms and a higher ICU mortality rate [14] . These results highlight the relevance of the observation that empirical therapy contributed substantially to antimicrobial consumption in this study.…”

“…Empirical therapy was the most common indication for prescribing, accounting for 50% of antimicrobial courses and for 54% of consumption. A prospective evaluation in a surgical and trauma ICU found that of 312 patients receiving empirical therapy only 25.6% were found to have an infection [14] . The empirical antibiotic group had a greater number of total antibiotic days, was more likely to develop a confirmed infection, and had more resistant organisms and a higher ICU mortality rate [14] .…”

Antimicrobial Stewardship Programs: Appropriate Measures and Metrics to Study their Impact

“…It suffers from many of the same problems as mortality, especially with secular trends in developed countries where an emphasis has been placed on early discharges. Attempts to discontinue or transition to oral antimicrobial therapy from parenteral therapy has, perhaps, the strongest relationship to length of stay [ 41 , 67 , 68 ••, 69 ]. Rather than hospital length of stay, some interventions use intensive care unit length of stay as a surrogate for clinical improvement [ 68 ••, 69 ].…”

A scoping review of registry captured indicators for evaluating quality of critical care in ICU.

“…The impact of this missingness being that several studies had to exclude data in analysis [106,111,124,125]. Challenges with data quality were described at point of data capture and extraction [30,33,34,40,63,84,87,90,101,108,118,120,143]. Ability to accurately measure processes of care associated with the indicator (e.g., time of antibiotic administration in the context of recognition of infection/ prescription of antibiotics) hindered utilization of the indicator in care evaluations [32,46,50,51,58,98,103,120,144,145].…”