TY - JOUR
T1 - Opportunities to Improve Antibiotic Appropriateness in U.S. ICUs
T2 - A Multicenter Evaluation
AU - Trivedi, Kavita K.
AU - Bartash, Rachel
AU - Letourneau, Alyssa R.
AU - Abbo, Lilian
AU - Fleisher, Jorge
AU - Gagliardo, Christina
AU - Kelley, Shannon
AU - Nori, Priya
AU - Rieg, Gunter K.
AU - Silver, Phyllis
AU - Srinivasan, Arjun
AU - Vargas, Jaclyn
AU - Ostrowsky, Belinda
N1 - Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020
Y1 - 2020
N2 - Objectives: To use a standardized tool for a multicenter assessment of antibiotic appropriateness in ICUs and identify local antibiotic stewardship improvement opportunities. Design: Pilot point prevalence conducted on October 5, 2016; point prevalence survey conducted on March 1, 2017. Setting: ICUs in 12 U.S. acute care hospitals with median bed size 563. Patients: Receiving antibiotics on participating units on March 1, 2017. Interventions: The Centers for Disease Control and Prevention tool for the Assessment of Appropriateness of Inpatient Antibiotics was made actionable by an expert antibiotic stewardship panel and implemented across hospitals. Data were collected by antibiotic stewardship program personnel at each hospital, deidentified and submitted in aggregate for benchmarking. hospital personnel identified most salient reasons for inappropriate use by category and agent. Measurements and Main Results: Forty-seven ICUs participated. Most hospitals (83%) identified as teaching with median licensed ICU beds of 70. On March 1, 2017, 362 (54%) of 667 ICU patients were on antibiotics (range, 8-81 patients); of these, 112 (31%) were identified as inappropriate and administered greater than 72 hours among all 12 hospitals (range, 9-82%). Prophylactic antibiotic regimens and PICU patients demonstrated a statistically significant risk ratio of 1.76 and 1.90 for inappropriate treatment, respectively. Reasons for inappropriate use included unnecessarily broad spectrum (29%), no infection or nonbacterial syndrome (22%), and duration longer than necessary (21%). Of patients on inappropriate antibiotic therapy in surgical ICUs, a statistically significant risk ratio of 2.59 was calculated for noninfectious or nonbacterial reasons for inappropriate therapy. Conclusions: In this multicenter point prevalence study, 31% of ICU antibiotic regimens were inappropriate; prophylactic regimens were often inappropriate across different ICU types, particularly in surgical ICUs. Engaging intensivists in antibiotic stewardship program efforts is crucial to sustain the efficacy of antibiotics and quality of infectious diseases care in critical care settings. This study underscores the value of standardized assessment tools and benchmarking to be shared with local leaders for targeted antibiotic stewardship program interventions.
AB - Objectives: To use a standardized tool for a multicenter assessment of antibiotic appropriateness in ICUs and identify local antibiotic stewardship improvement opportunities. Design: Pilot point prevalence conducted on October 5, 2016; point prevalence survey conducted on March 1, 2017. Setting: ICUs in 12 U.S. acute care hospitals with median bed size 563. Patients: Receiving antibiotics on participating units on March 1, 2017. Interventions: The Centers for Disease Control and Prevention tool for the Assessment of Appropriateness of Inpatient Antibiotics was made actionable by an expert antibiotic stewardship panel and implemented across hospitals. Data were collected by antibiotic stewardship program personnel at each hospital, deidentified and submitted in aggregate for benchmarking. hospital personnel identified most salient reasons for inappropriate use by category and agent. Measurements and Main Results: Forty-seven ICUs participated. Most hospitals (83%) identified as teaching with median licensed ICU beds of 70. On March 1, 2017, 362 (54%) of 667 ICU patients were on antibiotics (range, 8-81 patients); of these, 112 (31%) were identified as inappropriate and administered greater than 72 hours among all 12 hospitals (range, 9-82%). Prophylactic antibiotic regimens and PICU patients demonstrated a statistically significant risk ratio of 1.76 and 1.90 for inappropriate treatment, respectively. Reasons for inappropriate use included unnecessarily broad spectrum (29%), no infection or nonbacterial syndrome (22%), and duration longer than necessary (21%). Of patients on inappropriate antibiotic therapy in surgical ICUs, a statistically significant risk ratio of 2.59 was calculated for noninfectious or nonbacterial reasons for inappropriate therapy. Conclusions: In this multicenter point prevalence study, 31% of ICU antibiotic regimens were inappropriate; prophylactic regimens were often inappropriate across different ICU types, particularly in surgical ICUs. Engaging intensivists in antibiotic stewardship program efforts is crucial to sustain the efficacy of antibiotics and quality of infectious diseases care in critical care settings. This study underscores the value of standardized assessment tools and benchmarking to be shared with local leaders for targeted antibiotic stewardship program interventions.
KW - antibiotic appropriateness
KW - antibiotic stewardship programs
KW - inappropriate use
KW - intensive care units
KW - point prevalence
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U2 - 10.1097/CCM.0000000000004344
DO - 10.1097/CCM.0000000000004344
M3 - Article
C2 - 32317600
AN - SCOPUS:85087453309
SN - 0090-3493
SP - 968
EP - 976
JO - Critical care medicine
JF - Critical care medicine
ER -