García-García MA, Bértolo-Domínguez M, Aparisi-Valero MN, Lluna-Pérez L, Gómez-Úbeda G, Parreño-Rodríguez E, Arizo-León D, Palomo-Navarro M, Calabuig-Gillén C, Rosero-Arenas MA.
Rationale: Antibiotic treatment is common practice within the ICUs. Up to 30-60% of antibiotics used in ICUs are considered unnecessary, inappropriate or suboptimal.
Objectives: Describe the use of antibiotics in patients from our ICU, including medical, post-surgical and polytrauma patients; describe the presented infections and multi-resistant (MR) germs; and assess the influence of this pattern of antibiotic treatment in the presence of MR germs in our unit.
Findings: From January to October 2019, 489 patients were admitted to the ICU, with a median age of 69.4 years. 46 patients died during their stay in the ICU (16%) and 57 patients died during all their hospital stay (19,8%). The scheduled postsurgical patients had the lowest hospital mortality (5%), followed by urgent postsurgical (19.5%), traumatological (25%) and medical patients (27%). There were 134 patients with ICU infections: community and nosocomial pneumonia (31.3%), intra-abdominal infections (29.9%), urinary infections (11.2%), and associated and not associated with mechanical ventilation tracheobronquitis (9.7% each other). There were MR germs in 46 patients. Patients with infection had a higher mortality (21.64 vs. 11.49%) and longer hospital stay -13 vs. 9 days-. There are elevated percentages of empirical (50%) and by surgical prophylaxis (36.1%) at initial antibiotic use. The most used antibiotics were amoxicillin/clavulanic, piperacillin/tazobactam, levofloxacin and ceftriaxone. The indications of beta-lactams exceeded 50% of the total prescriptions. The number of total days without antibiotic treatment related to total hospital days of patients with antibiotic treatment was 0.085. 34% of antibiotic treatment were adequate, 18.9% inadequate, 32% had negative cultures and in 15.1% no cultures were extracted.
Conclusion: There are several ítems related to antibiotic use in our ICU that must be improved.View pdf