Role of the infectious diseases specialist consultant on the appropriateness of antimicrobial therapy prescription in an intensive care unit

Raineri, Enrico; Pan, Angelo; Mondello, Placido; Acquarolo, Annamaria; Candiani, A; Crema, Luciano

doi:10.1016/j.ajic.2007.06.009

Cited by 87 publications

(48 citation statements)

References 41 publications

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“…Superior empiric coverage can be obtained using local and unit-specific antibiograms [113,114] or an infectious diseases consultation [115][116][117]. Where uncertainty regarding appropriate patient-specific antimicrobial therapy exists, infectious diseases consultation is warranted.…”

Section: We Recommend Empiric Broad-spectrum Therapymentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

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Section: We Recommend Empiric Broad-spectrum Therapymentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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“…While inappropriate prescription rates ranging from 31% to 77% have previously been reported, this is nevertheless unacceptable in an environment of increasing drug resistance. [1][2][3][4][5] The higher rate in the private sector might be explained by the greater number of 'open' ICUs in this sector where the lack of a director permits all attending doctors to prescribe antibiotics as and when they wish, often without sufficient knowledge of the pharmacology of the drugs or the epidemiology of the unit.…”

Section: Discussionmentioning

confidence: 99%

“…2,4 Kumar et al recently reported that inappropriate antibiotic prescription results in a fivefold mortality increase in septic shock. 16 It is cause for concern that an inappropriate antibiotic is initiated in approximately 55% of patients.…”

Section: Discussionmentioning

confidence: 99%

“…1 A major concern is the almost universal observation that 31 -77% of these are inappropriate. [1][2][3][4][5] The inappropriate use of antibiotics is associated with increased morbidity, mortality and cost, and is a major driver in the emergence of resistant pathogens. Antibiotic prescription practices in South African intensive care units (ICUs) have not been described in the public or private sectors.…”

mentioning

confidence: 99%

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Antibiotic prescription practices and their relationship to outcome in South Africa: Findings of the prevalence of infection in South African intensive care units (PISA) study

et al. 2012

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“…[3][4][5] Based on these premises we were interested in evaluating the modality of use of antibiotics in the wards of Internal Medicine of several hospitals of Lazio (an Italian region), focusing on number of treated patients, appropriateness of indications, preferred antibiotic classes, and followed stewardship programs (i.e., deescalation and/or rotation of antimicrobials).…”

Section: Antibiotic Use In Departments Of Internal Medicine Of Laziomentioning

confidence: 99%

Antibiotic use in Departments of Internal Medicine of Lazio

Martolini

Santoro

et al. 2017

Ital J Med

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Antimicrobial therapy is inappropriate in 9 to 64% of the patients hospitalized. We evaluated the antibiotic use in Internal Medicine wards of an Italian region (Lazio) by a prospective multicenter, observational study. One thousand and nine patients were evaluated. Patients under antimicrobial treatment (PUAT) were 588 (58.2%), patients without treatment (PWT) 421 (41.8%). Infections were classified as community acquired (47.8%), hospital acquired (10.3%) or healthcare-associated (11.4%); the remaining 30.5% of infections did not receive any epidemiological classification. Samples for microbiological examination were collected in 41.6% of PUAT. The antibiotic choice was empiric in 94.8% of the cases and protected penicillins were selected in 48% of the cases. The mean duration of treatment was 9.5±6 standard deviation (SD) days. Only 6% of the patients switched from intravenous to oral therapy. Age, length of hospital stay and mortality were higher for PUAT than for PWT (mean age: 75.9±15 SD vs 74.2±15 SD years, P<0.02; length of hospital stay: 13.7±10.4 SD vs 10±8.4 SD days, P<0.01; mortality: 15.9% vs 3.1%). Antibiotic stewardship needs to be implemented all over the hospitals of Lazio region.

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Role of the infectious diseases specialist consultant on the appropriateness of antimicrobial therapy prescription in an intensive care unit

Cited by 87 publications

References 41 publications

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Antibiotic prescription practices and their relationship to outcome in South Africa: Findings of the prevalence of infection in South African intensive care units (PISA) study

Antibiotic use in Departments of Internal Medicine of Lazio

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