Although most patients in the intensive care unit (ICU) receive
antibiotics, little is known about patterns of
antibiotic use in ICUs in Japan. The objective of this study was to evaluate the pattern of
antibiotic use in ICUs. A nationwide one-day cross-sectional surveillance of
antibiotic use in the ICU was conducted three times between January 2011 and December 2011. All patients aged at least16 years were included. Data from 52 ICUs and 1148 patients were reviewed. There were 1028 prescriptions for intravenous
antibiotics. Of 1148 patients, 834 (73%) received at least one intravenous
antibiotic, and 575 had at least one known site of
infection. Respiratory and
intra-abdominal infections were the two most common types. Of 1028 prescriptions, 331 (34%) were for surgical or medical prophylaxis. Excluding prophylaxis,
carbapenems were the most commonly prescribed agent.
Infectious disease consultations, pre- and post-prescription antimicrobial stewardship, and ICU-dedicated antibiograms were available in 44%, 52%, 77%, and 21% of the ICUs, respectively. In logistic regression analysis adjusting for patient characteristics, treatment in a university hospital (adjusted odds ratio, 1.72; 95% CI, 1.05-2.84; P = 0.033) and an open ICU (adjusted odds ratio, 2.30; 95% CI, 1.02-5.17; P = 0.044) were significantly associated with greater likelihood of
carbapenem use. An increase in the number of closed ICUs and more
intensive care specialists may reduce
carbapenem use in Japanese ICUs. Large-scale epidemiological studies of antimicrobial resistance in the ICU are needed.