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 Beta-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.
AD - Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD. Joel_Dulhunty@health.qld.gov.au. AN - 21261573 BT - Critical Care and Resuscitation ET - 2011/01/26 LA - eng M1 - 3 N1 - Dulhunty, Joel MWebb, Steven A RPaterson, David LBellomo, RinaldoMyburgh, JohnRoberts, Jason ALipman, JeffreyAustraliaCritical care and resuscitation : journal of the Australasian Academy of Critical Care MedicineCrit Care Resusc. 2010 Sep;12(3):162-70. N2 -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 Beta-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.
PY - 2010 SN - 1441-2772 (Print)1441-2772 (Linking) SP - 162 EP - 70 T2 - Critical Care and Resuscitation TI - A survey of antibiotic prescribing practices in Australian and New Zealand intensive care units VL - 12 ER -