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

Dulhunty, Joel, Webb, Steven, Paterson, David, Bellomo, Rinaldo, Myburgh, John, Roberts, Jason and Lipman, Jeffrey (2010) A survey of antibiotic prescribing practices in Australian and New Zealand intensive care units. Critical Care and Resuscitation, 12 3: 162-170.


Author Dulhunty, Joel
Webb, Steven
Paterson, David
Bellomo, Rinaldo
Myburgh, John
Roberts, Jason
Lipman, Jeffrey
Title A survey of antibiotic prescribing practices in Australian and New Zealand intensive care units
Journal name Critical Care and Resuscitation   Check publisher's open access policy
ISSN 441-2772
Publication date 2010-09
Sub-type Critical review of research, literature review, critical commentary
Volume 12
Issue 3
Start page 162
End page 170
Total pages 9
Place of publication Bedford Park, South Australia
Publisher Australasian Academy of Critical Care Medicine
Collection year 2011
Language eng
Formatted 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 -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.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2011 Collection
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 11 times in Thomson Reuters Web of Science Article | Citations
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Created: Thu, 24 Feb 2011, 18:12:10 EST by Sia Athanasas on behalf of Anaesthesiology and Critical Care - RBWH