INDICATIONS FOR ANTIBIOTIC USE IN ICU PATIENTS - A ONE-YEAR PROSPECTIVE SURVEILLANCE

The high prevalence of nosocomial infections in critically ill ICU pat ients is associated with high antibiotic consumption. Besides its econ omic impact, there is the constant threat of selection and induction o f antibiotic resistance. Surveillance studies recording the incidence of infections, antibiotic use, and antimicrobial susceptibilities of p athogens supply vital information regarding infection control and prev ention of antibiotic resistance. In order to analyse antibiotic consum ption we recorded antibiotic use in a general ICU during one year by c ategorizing the indications for antibiotic use into three groups; (i) prophylaxis; (ii) therapy for a bacteriologically proven infection (BP I); (iii) therapy for a non-bacteriologically proven infection (non-BP I). Bronchoscopic techniques were used to diagnose pneumonia. In pract ice, BPI must be treated, but a proportion of antibiotics prescribed f or non-BPI may be unnecessary. The subdivision in BPI and non-BPI may help to identify these cases. In all, 515 patients were admitted to IC U and 36% of these had at least one infection. Of all infections, 53% were ICU-acquired and 99% of these occurred in intubated patients. Ant ibiotics were prescribed in 61% of admissions. Of all antibiotics pres cribed for therapy, 49% were for respiratory tract infections, 19% for abdominal infections and 13% for sepsis eci. Categorized by indicatio n, 59% of all antibiotic prescriptions were for BPI, 28% for non-BPI a nd 13% for prophylaxis. A theoretical reduction of 25% in the number o f non-BPI prescriptions would result only in a 7% decrease of total an tibiotic use. We conclude that almost all antibiotics prescribed were for intubated patients and for BPI. Respiratory infections were the si ngle most common infection and accounted for 49% of all antibiotics us ed. Therefore, in our setting, prevention of respiratory tract infecti ons is probably the most effective mode to reduce antibiotic use.