Cost and morbidity associated with antibiotic prophylaxis in the ICU

Background: Although the high cost and inappropriate use of antibiotics hav e been documented before, we are not aware of any data on nonsurgical site infectious morbidity associated with prolonged courses of prophylactic anti biotics (PA). Study Design: Data regarding antibiotic orders were collected using a custo m designed microbiology database in the Surgical Intensive Care Unit of a t eaching hospital from October 1, 1995 through April 30, 1997. The database was retrospectively reviewed. The cost of PA in excess of 1 day was calcula ted. Frequency of bacteremia and line infections were compared in patients receiving 1 day or less of PA versus more than 4 days of PA. Results: Sixty-one percent of PA orders were continued for more than 1 day. Cost of PA beyond 1 day totaled $44,893. Bacteremia and line infection wer e more frequent in the patients receiving more than 4 days of PA. Conclusions: There was poor compliance with the protocol of stopping PA at 24 hours. The cost of noncompliance was $44,893. There were more bacteremia s and line infections in patients with duration of PA of more than 4 days. (J Am Coil Surg 1999;188:225-230. (C) 1999 by the American College of Surge ons).