A survey of antibiotic prescribing practices in Australian and New Zealand intensive care units.

Abstract

OBJECTIVE:

To evaluate antibiotic prescribing practices in empirical and directed treatment of severe sepsis and septic shock in Australian and New Zealand intensive care units.

DESIGN, SETTING AND PARTICIPANTS:

Case vignette survey of intended antibiotic prescribing for ICU patients with sepsis associated with community-acquired pneumonia (CAP), intra-abdominal infection (IAI), hospital-acquired pneumonia (HAP) or an unidentified infectious cause (UIC). Eighty-four specialists and advanced trainees working in an ICU setting in Australia and New Zealand responded to a questionnaire survey conducted between February and May 2009.

MAIN OUTCOME MEASURES:

Empirical and directed antibiotic therapy, including mode of administration, frequency of administration, dose and duration of therapy.

RESULTS:

A total of 656 antibiotics were empirically "prescribed", including 25 unique antibiotics. Combination therapy was prescribed in 82% of cases, with dual cover for CAP and triple therapy for IAI most common. Directed single-agent cover for Pseudomonas aeruginosa in HAP and flucloxacillin monotherapy for methicillin-sensitive Staphylococcus aureus bacteraemia were prescribed in 65% and 51% of cases, respectively. Supportive gentamicin therapy was commonly recommended (32% of all cases), predominantly in the form of once-daily dosing. Daily gentamicin dosage varied from 3 to 7mg/kg (excluding one outlier), and was largely compliant with recommendations (76% of doses being ≥5 mg/kg). Main areas of noncompliance with guidelines were provision of broader cover for resistant organisms and Β-lactam underdosing. Continuous and extended infusions were uncommon (5%).

CONCLUSIONS:

Antibiotic prescribing was largely appropriate, but consideration of site-specific resistance profiles and avoidance of low dosing is advocated to provide appropriate upfront cover, prevent underdosing and reduce the risk of developing resistant organisms.

• Authors: Joel M Dulhunty, Steven A R Webb, David L Paterson, Rinaldo Bellomo, John Myburgh, Jason A Roberts, Jeffrey Lipman
• Journal: Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine (Crit Care Resusc) Vol. 12 Issue 3 Pg. 162-70 (Sep 2010) ISSN: 1441-2772 [Print] Netherlands
• PMID: 21261573 (Publication Type: Journal Article)

Chemical References

• Anti-Bacterial Agents

Topics

• Anti-Bacterial Agents (therapeutic use)
• Australia
• Cross Infection (prevention & control)
• Humans
• Intensive Care Units
• New Zealand
• Staphylococcus aureus
• Surveys and Questionnaires