Antibiotic stewardship at the ICU: stop therapy on time!


    Lisa Dol1, Suzanne Harvey1 , Judith van Paassen


    1Department of Intensive Care Medicine, Leiden University Medical Centre, Leiden University, Leiden, the Netherlands


    Antibiotic stewardship at the ICU: stop therapy on time!

    Teaser: Inductie van BRMO en bijwerkingen maken overmatig gebruik van antibiotica op de IC onwenselijk. De afgelopen jaren neemt het gebruik van meropenem en vancomycine echter toe. Een prospectieve analyse van 126 voorschriften toonde 22 onjuistheden, het merendeel betrof behandelduur van empirisch gestarte therapie. Antibiotic stewardship op de IC is nuttig om na te gaan waar aangrijpingspunten liggen om antibioticagebruik te optimaliseren. 

    Background: ICU patients are vulnerable and due to the need to treat infections on time and adequately, there is a potential risk of the overuse of antibiotics, with all the associated adverse consequences (e.g. induction of BRMO and associated adverse effects) that overuse brings (1). Annual usage rate analysis in the context of the antibiotic stewardship program (ASP) at the 26-bed ICU of the LUMC showed an evident increase in antibiotic use, both in days on therapy (DOT)/1000 patient days and in antibiotic spectrum index (ASI) (2) corrected figures (figure 1). In order to assess whether there are areas for improvement, it was desirable to gain more insight into the background of this increased use. 

    Aim: The aim of the present study was to analyze each prescription of meropenem and vancomycin for accuracy in terms of indication and duration of treatment, and to determine where improvements can be achieved.

    Methods: Every meropenem and vancomycin prescription was gathered (as email alerts), and prospectively compared to the current guidelines with regard to indication and duration of treatment. All new prescriptions from June 1rst to November 30th were included. The accuracy of the indication was assessed on the basis of the guidelines and protocols applicable in the LUMC (all established by the hospital-wide antibiotic committee).

    Results: In a patient population of 1045 patients that were admitted to the ICU from June-November 2023, 126 (53 meropenem and 73 vancomycin) prescriptions were analyzed (table 1). Of these, 104 (82%) were judged as correct. The remaining of 22 prescriptions (7 for meropenem and 15 for vancomycin) were considered incorrect. In four cases this concerned an incorrect indication, but most prescriptions involved an incorrect treatment duration. In particular, empirically initiated therapy could have been stopped earlier in the event of negative cultures, which were available after 48 hours (range 3-6 days).

    Conclusion: Antibiotic stewardship in the ICU is useful. Points of action for antibiotic stewardship in the ICU appear to lie more in monitoring the duration of therapy and less in the indication.

    Figure 1: Yearly antibiotic use at the ICU department of the LUMC

    Table 1: Analysis of meropenem and vancomycin prescriptions in ICU patients, June-November 2023


    1. Brusselaers N, Vogelaers D, et al. The rising problem of antimicrobial resistance in the intensive care unit. Ann Intensive Care. 2011 Nov 23;1:47
    2. Sijbom M, Büchner FL, et al. Trends in antibiotic selection pressure generated in primary care and their association with sentinel antimicrobial resistance patterns in Europe. J Antimicrob Chemother. 2023 May 3;78(5):1245-1252.