Critical Care, Mythbusting

Prolonged ICU antibiotics

Trailing the heels of my last post, comes this :

67 ICUs from 32 hospitals. 998 patients admitted to these ICUs within a 24 hour period.

Of the 660 empirically ordered antibiotics, 50% were continued for at least 72 hours in instances where CDC infection criteria were not met. Of course, antibiotics leading the charge were vancomycin (27%) and piperacillin-tazobactam (21%) with the next highest being meropenem (6%).

Most alarming, many touted institutional factors were not associated with a change in prolonged IV therapy- not a stewardship program, not CPOE, not institutional protocols or self-reported utilization of guidelines, not a predominant case mix of trauma/MICU/SICU, not pharmacist rounding, not a closed ICU, not implementation of VAP protocols. None of these lowered rates of prolonged empiric antibiotic therapy.

The ONE factor that decreased prolonged empiric antibiotic therapy? ICUs that utilized invasive techniques to diagnosis ventilator associated pneumonia had lower rates of prolonged empiric antibiotic therapy (45.1% vs 59.5%).

Are we doing these patients any good? Are we giving them broad spectrum antibiotics just to say were doing something? The previous post suggested that perhaps prolonged IV therapy may prove to be more harmful than beneficial. Only time and larger scale trials will tell, though I would not be at all surprised if prolonged therapy proves to be more problematic than helpful for patients.

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