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A complete and multifaceted overview of antibiotic use and infection diagnosis in the intensive care unit : results from a prospective four-year registration

Liesbet De Bus (UGent) , Bram Gadeyne (UGent) , Johan Steen (UGent) , Jerina Boelens (UGent) , Geert Claeys (UGent) , Dominique Benoit (UGent) , Jan De Waele (UGent) , Johan Decruyenaere (UGent) and Pieter Depuydt (UGent)
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Abstract
Background: Preparing an antibiotic stewardship program requires detailed information on overall antibiotic use, prescription indication and ecology. However, longitudinal data of this kind are scarce. Computerization of the patient chart has offered the potential to collect complete data of high resolution. To gain insight in our global antibiotic use, we aimed to explore antibiotic prescription in our intensive care unit (ICU) from various angles over a prolonged time period. Methods: We studied all adult patients admitted to Ghent University Hospital ICU from 1 January 2013 until 31 December 2016. Antibiotic prescription data were prospectively merged with diagnostic (suspected focus, severity and probability of infection at the time of prescription, or prophylaxis) and microbiology data by ICU physicians during daily workflow through dedicated software. Definite focus of infection and probability of infection (classified as high/moderate/low) were reassessed by dedicated ICU physicians at patient discharge. Results: During the study period, 8763 patients were admitted and overall antibiotic consumption amounted to 1232 days of therapy (DOT)/1000 patient days. Antibacterial DOT (84% of total DOT) were linked with infection in 80%; the predominant foci were the respiratory tract (49%) and the abdomen (19%). A microbial cause was identified in 56% (3169/5686). Moderate/low probability infections accounted for 42% of antibacterial DOT prescribed for respiratory tract infections; for abdominal infections, this figure was 15%. The median treatment duration of moderate/low probability respiratory infections was 4 days (IQR 3-7). Antifungal DOT (16% of total DOT) were linked with infection in 47% of total antifungal DOT. Antifungal prophylaxis was primarily administered in the surgical ICU (76%), with a median duration of 4 DOT (IQR 2-9). Conclusions: By prospectively combining antibiotic, microbiology and clinical data we were able to construct a longitudinal, multifaceted dataset on antibiotic use and infection diagnosis. A complete overview of this kind may allow the identification of antibiotic prescription patterns that require future antibiotic stewardship attention.
Keywords
Antibiotic stewardship, Intensive care unit, Electronic surveillance, Longitudinal surveillance, Infection, ANTIMICROBIAL STEWARDSHIP, ELECTRONIC SURVEILLANCE, DISEASES SOCIETY, FRACTURES, ICU, METAANALYSIS, PROPHYLAXIS, GUIDELINES, MANAGEMENT, DURATION

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MLA
De Bus, Liesbet, Bram Gadeyne, Johan Steen, et al. “A Complete and Multifaceted Overview of Antibiotic Use and Infection Diagnosis in the Intensive Care Unit : Results from a Prospective Four-year Registration.” CRITICAL CARE 22 (2018): n. pag. Print.
APA
De Bus, L., Gadeyne, B., Steen, J., Boelens, J., Claeys, G., Benoit, D., De Waele, J., et al. (2018). A complete and multifaceted overview of antibiotic use and infection diagnosis in the intensive care unit : results from a prospective four-year registration. CRITICAL CARE, 22.
Chicago author-date
De Bus, Liesbet, Bram Gadeyne, Johan Steen, Jerina Boelens, Geert Claeys, Dominique Benoit, Jan De Waele, Johan Decruyenaere, and Pieter Depuydt. 2018. “A Complete and Multifaceted Overview of Antibiotic Use and Infection Diagnosis in the Intensive Care Unit : Results from a Prospective Four-year Registration.” Critical Care 22.
Chicago author-date (all authors)
De Bus, Liesbet, Bram Gadeyne, Johan Steen, Jerina Boelens, Geert Claeys, Dominique Benoit, Jan De Waele, Johan Decruyenaere, and Pieter Depuydt. 2018. “A Complete and Multifaceted Overview of Antibiotic Use and Infection Diagnosis in the Intensive Care Unit : Results from a Prospective Four-year Registration.” Critical Care 22.
Vancouver
1.
De Bus L, Gadeyne B, Steen J, Boelens J, Claeys G, Benoit D, et al. A complete and multifaceted overview of antibiotic use and infection diagnosis in the intensive care unit : results from a prospective four-year registration. CRITICAL CARE. 2018;22.
IEEE
[1]
L. De Bus et al., “A complete and multifaceted overview of antibiotic use and infection diagnosis in the intensive care unit : results from a prospective four-year registration,” CRITICAL CARE, vol. 22, 2018.
@article{8576062,
  abstract     = {Background: Preparing an antibiotic stewardship program requires detailed information on overall antibiotic use, prescription indication and ecology. However, longitudinal data of this kind are scarce. Computerization of the patient chart has offered the potential to collect complete data of high resolution. To gain insight in our global antibiotic use, we aimed to explore antibiotic prescription in our intensive care unit (ICU) from various angles over a prolonged time period. 
Methods: We studied all adult patients admitted to Ghent University Hospital ICU from 1 January 2013 until 31 December 2016. Antibiotic prescription data were prospectively merged with diagnostic (suspected focus, severity and probability of infection at the time of prescription, or prophylaxis) and microbiology data by ICU physicians during daily workflow through dedicated software. Definite focus of infection and probability of infection (classified as high/moderate/low) were reassessed by dedicated ICU physicians at patient discharge. 
Results: During the study period, 8763 patients were admitted and overall antibiotic consumption amounted to 1232 days of therapy (DOT)/1000 patient days. Antibacterial DOT (84% of total DOT) were linked with infection in 80%; the predominant foci were the respiratory tract (49%) and the abdomen (19%). A microbial cause was identified in 56% (3169/5686). Moderate/low probability infections accounted for 42% of antibacterial DOT prescribed for respiratory tract infections; for abdominal infections, this figure was 15%. The median treatment duration of moderate/low probability respiratory infections was 4 days (IQR 3-7). Antifungal DOT (16% of total DOT) were linked with infection in 47% of total antifungal DOT. Antifungal prophylaxis was primarily administered in the surgical ICU (76%), with a median duration of 4 DOT (IQR 2-9). 
Conclusions: By prospectively combining antibiotic, microbiology and clinical data we were able to construct a longitudinal, multifaceted dataset on antibiotic use and infection diagnosis. A complete overview of this kind may allow the identification of antibiotic prescription patterns that require future antibiotic stewardship attention.},
  articleno    = {241},
  author       = {De Bus, Liesbet and Gadeyne, Bram and Steen, Johan and Boelens, Jerina and Claeys, Geert and Benoit, Dominique and De Waele, Jan and Decruyenaere, Johan and Depuydt, Pieter},
  issn         = {1466-609X},
  journal      = {CRITICAL CARE},
  keywords     = {Antibiotic stewardship,Intensive care unit,Electronic surveillance,Longitudinal surveillance,Infection,ANTIMICROBIAL STEWARDSHIP,ELECTRONIC SURVEILLANCE,DISEASES SOCIETY,FRACTURES,ICU,METAANALYSIS,PROPHYLAXIS,GUIDELINES,MANAGEMENT,DURATION},
  language     = {eng},
  pages        = {10},
  title        = {A complete and multifaceted overview of antibiotic use and infection diagnosis in the intensive care unit : results from a prospective four-year registration},
  url          = {http://dx.doi.org/10.1186/s13054-018-2178-7},
  volume       = {22},
  year         = {2018},
}

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