美国成人 ICU 中长期经验性抗生素治疗的多中心评估。

A Multicenter Evaluation of Prolonged Empiric Antibiotic Therapy in Adult ICUs in the United States.

机构信息

1Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscatway, NJ. 2Department of Pharmacy, Hackensack University Medical Center, Hackensack, NJ 3Department of Pharmacy, Saint Peter's University Hospital, New Brunswick, NJ. 4Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE. 5Department of Pharmacy Practice, School of Pharmacy, University of Connecticut/Hartford Hospital, Hartford, CT. 6Information and Technology Services, University of Nebraska Medical Center, Omaha, NE.

出版信息

Crit Care Med. 2015 Dec;43(12):2527-34. doi: 10.1097/CCM.0000000000001294.

DOI:10.1097/CCM.0000000000001294

PMID:26457751

Abstract

OBJECTIVE

The purpose of this study is to determine the rate of prolonged empiric antibiotic therapy in adult ICUs in the United States. Our secondary objective is to examine the relationship between the prolonged empiric antibiotic therapy rate and certain ICU characteristics.

DESIGN

Multicenter, prospective, observational, 72-hour snapshot study.

SETTING

Sixty-seven ICUs from 32 hospitals in the United States.

PATIENTS

Nine hundred ninety-eight patients admitted to the ICU between midnight on June 20, 2011, and June 21, 2011, were included in the study.

INTERVENTION

None.

MEASUREMENTS AND MAIN RESULTS

Antibiotic orders were categorized as prophylactic, definitive, empiric, or prolonged empiric antibiotic therapy. Prolonged empiric antibiotic therapy was defined as empiric antibiotics that continued for at least 72 hours in the absence of adjudicated infection. Standard definitions from the Centers for Disease Control and Prevention were used to determine infection. Prolonged empiric antibiotic therapy rate was determined as the ratio of the total number of empiric antibiotics continued for at least 72 hours divided by the total number of empiric antibiotics. Univariate analysis of factors associated with the ICU prolonged empiric antibiotic therapy rate was conducted using Student t test. A total of 660 unique antibiotics were prescribed as empiric therapy to 364 patients. Of the empiric antibiotics, 333 of 660 (50%) were continued for at least 72 hours in instances where Centers for Disease Control and Prevention infection criteria were not met. Suspected pneumonia accounted for approximately 60% of empiric antibiotic use. The most frequently prescribed empiric antibiotics were vancomycin and piperacillin/tazobactam. ICUs that utilized invasive techniques for the diagnosis of ventilator-associated pneumonia had lower rates of prolonged empiric antibiotic therapy than those that did not, 45.1% versus 59.5% (p = 0.03). No other institutional factor was significantly associated with prolonged empiric antibiotic therapy rate.

CONCLUSIONS

Half of all empiric antibiotics ordered in critically ill patients are continued for at least 72 hours in absence of adjudicated infection. Additional studies are needed to confirm these findings and determine the risks and benefits of prolonged empiric therapy in the critically ill.

摘要

目的

本研究旨在确定美国成人 ICU 中长期使用经验性抗生素治疗的比率。我们的次要目标是研究延长经验性抗生素治疗率与某些 ICU 特征之间的关系。

设计

多中心、前瞻性、观察性、72 小时快照研究。

地点

美国 32 家医院的 67 个 ICU。

患者

2011 年 6 月 20 日午夜至 6 月 21 日午夜期间入住 ICU 的 998 名患者被纳入研究。

干预措施

无。

测量和主要结果

抗生素医嘱分为预防、明确、经验性和延长经验性抗生素治疗。延长经验性抗生素治疗定义为在没有裁决感染的情况下至少持续 72 小时的经验性抗生素治疗。采用疾病控制与预防中心的标准定义来确定感染。延长经验性抗生素治疗率定义为至少持续 72 小时的总经验性抗生素数与总经验性抗生素数之比。使用学生 t 检验对与 ICU 延长经验性抗生素治疗率相关的因素进行单因素分析。共为 364 名患者开具了 660 种不同的抗生素作为经验性治疗。在未满足疾病控制与预防中心感染标准的情况下，660 种经验性抗生素中有 333 种（50%）至少持续 72 小时。疑似肺炎约占经验性抗生素使用的 60%。最常开的经验性抗生素是万古霉素和哌拉西林/他唑巴坦。使用侵入性技术诊断呼吸机相关性肺炎的 ICU 的延长经验性抗生素治疗率低于未使用的 ICU，分别为 45.1%和 59.5%（p=0.03）。没有其他机构因素与延长经验性抗生素治疗率显著相关。