engleski

Antibiotic prescription in ICU - ID specialist where are you?

Significance: Antimicrobial drugs are used very frequently in intensive care units (ICU). In order to reduce prevalence of resistant strains, to reduce incidence of nosocomial infections and lower costs of antimicrobial treatments there have been created numerous antibiotic restriction programs and there are many studies indicating that infectious diseases physicians (IDP) have been necessary to the success of these programs. Aim: To asses frequency of participance of IDP in prescribing antibiotics in surgical and interdisciplinar ICUs in Croatia Methods: Prospective, multicentric, observational study conducted in a three-month period (1st November 1998 to 31th January 1999) in ten intensive care units (four surgical, three interdisciplinar, one pulmology and two infectious diseases ICUs). Results: There were 1200 prescriptions in 615 (85.8%) patients ; 772 (64.3%) for therapy and 428 (35.7%) for prophylaxis. The main indications were: community acquired (71.4%), nosocomial infections (18.8%) and reason unknown (4.3%). The majority of prescriptions (77.2%) were empiric. Proportions of empiric prescriptions in surgical ICUs ranged from 14.8 to 30.4%, in general ICUs 4.3 to 21.0%, in pulmology ICU it was 44.9%, in infectious diseases ICU for children 31.9% and in in infectious diseases ICU for adults 30.6%. Combination of antimicrobial agents represented proportion of 67.5% (521 of 772 prescriptions). Proportion of combination therapy in surgical ICUs ranged from 58.8 to 88.9%, in general ICUs 65.6 to 79.0%, in pulmology ICU it was 48.0%, in infectious diseases ICU for children it was 58.0% and in infectious diseases ICU for adults 66.7%. The most frequent antibiotics were: caphalosporins (25.9%), aminoglycosides (21.4%) and penicillins (20.3%). In all of the surgical and general ICUs antimicrobial antimicrobial therapy was prescribed only by anaestesiologists. The most frequent reasons for terminating treatment were: success (29.8%), transfer to the medical ward (16.5%) and lethal outcome (13.6%). Conclusions: Infectious diseases physicians in Croatian ICUs do not participate in making decisions about antimicrobial treatment in surgical and interdisciplinar ICUs although they are crucial for the implementation of the antimicrobial management programs. They should be consulted more frequently in order to achieve better treatment results, more effective prophylaxis, lower treatment costs and lower resistance rates.

antibitotic prescription

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