Empirical use of antibiotics in adult intensive care unit: a real-life approach

Abstract

Introduction: Infection is the leading cause of complications in critically ill, and its presence signifi cantly infl uences the treatment outcome. Empirical antibiotic therapy (EAT) is justifi ed if limited to the time required for isolation and identifi cation of pathogen, which is considered not to exceed 72 hours. Aim: The aim of this study was to determine the rate of prolonged empirical antibiotic therapy (PEAT) in adult intensive care unit (ICU) -treated patients at the third level hospital and to assess factors infl uencing the antibiotic prescription practice in the hospital. The study also aimed to assess in-hospital mortality in patients treated with empirical antibiotic therapy (EAT) and to fi nd parameters that were associated with fatal outcome. Subjects and Methods: Prospective observational study involved 51 consecutive patient who underwent EAT. Demographic, clinical and laboratory data were collected. The rate of PEAT was determined as the ratio of the total number of patients who received EAT longer than 72 hours divided by the total number of patients who received EAT regardless the length of its duration. Results: The rate of PEAT was 80%. In patients with diagnosed infection, length of EAT depended on the time needed for bacteria isolation. However, EAT was introduced and even prolonged in 33% of patients, in which infection was never confi rmed. In-hospital mortality was 20%, and factors associated with death outcome were ongoing sepsis and longer EAT. Conclusions: The practice of prescribing prolonged antibiotic therapy is very common in this study. This is associated with higher mortality, so it is necessary to fi nd the cost-eff ective diagnostic method that helps in adjustment of rational empirical antibiotic treatment in ICU. Age of patients (years), M (IQR 25-75%)1 68 (63.75-83) 64 (54-74) Length of EAT 2 (days), M (IQR 25-75%) 1 5.5 (3.75-8) 6 (5-8) Length of hospitalization (days), M (IQR 25-75%) 1 14 (9.75-19) 10 (8.5-16.5) Biomarkers of bacterial infection, N (%) 26 (70.47) * 5 (29.41) Clinical features, N (%) 27 (79.41) 14 (82.35) Appropriate EAT 2 , N (%) 13 (38.24) 5 (29.41) Sepsis, N (%) 11 (32.35) ** 0 (0.00) Critically ill patients, N (%) 26 (70.47) 11 (64.71) The most signifi cant comorbidities, N (%) Cardiac arrhythmia 4 (11.76) 3 (17.65) Hypertension 26 (70.47) 9 (52.94) Diabetes mellitus 9 (26.47) 2 (11.76) Malignancy 9 (26.47) 4 (23.53) Age of patients (years), M (IQR 25-75%) 1 73.5 (66.5-83) 68 (62.25-80.25) Length of EAT 2 (days), M (IQR 25-75%) 1 7.5 (5.5-11)* 5 (3-7) Length of hospitalization (days), M (IQR 25-75%) 1 16 (10.5-21) 13 (9-17) Length of hospitalization before isolation of bacteria (days), M (IQR 25-75%) 1 7.5 (6-10.5)* 5 (3-6.25) Biomarkers of bacterial infection, N (%) 10 (100.0) 16 (66.67) Clinical features, N (%) 10 (100.0) 17 (70.83) Appropriate EAT 2 , N (%) 4 (40.0) 9 (37.5) Sepsis, N (%) 7 (70.0)** 4 (16.67) Critically ill patients, N (%) 9 (90.0) 17 (70.83) The most signifi cant comorbidities, N (%) Cardiac arrhythmia 3 (30.0) 2 (8.33) Hypertens...