title: Dynamics of antibiotic usage in the intensive care unit at the University Hospital of the West Indies.
abstract: OBJECTIVE
  To determine antibiotic usage patterns in the Intensive Care Unit (ICU) at the University Hospital of the West Indies (UHWI).
  
  
  METHODS
  A cross-sectional, analytical study of consecutive patients admitted to the ICU was conducted between July and December 2007. Exclusion criteria were HIV-positive patients, patients < 12 years and those discharged or who died within 48 hours of admission. Data were collected from medical records, stored and analysed using the SPSS Version 12.
  
  
  RESULTS
  Of the 150 eligible patients, 109 had complete data (73%). Mean age was 50.8 +/- 20.7 years, with mean APACHE II score of 15.6 +/- 6.7. Forty-five patients (41.3%) received prophylactic antibiotics, most commonly ceftriaxone (31.7%) and metronidazole (19.0%). Appropriate discontinuation within 24 hours occurred in only 11.1%. Two-thirds of patients (67.9%) were treated with empiric antibiotics, most commonly piperacillin/tazobactam (32.1%), ceftazidime (27.5%) or metronidazole (27.5%). Reasons for empiric choice were primarily coverage of organisms based on presumed source of sepsis (45.6%), and broad spectrum, high-powered coverage (23.5%). Courses ranged from 1 - 42 days and were adequate based on subsequent cultures in 71% of cases. Culture reports took between 2 - 8 days with a mean of 3.7 days to become available. De-escalation was practised in only 2 of 26 (7.7%) cases and intravenous to oral switch therapy in only 3.3%. Thirty-two (29.4%) patients died, with sepsis being a cause in 12 (37.5%).
  
  
  CONCLUSIONS
  Improved attention to discontinuation of prophylactic antibiotics, appropriate duration of antibiotic courses and de-escalation are essential if the antibiotic practices in the ICU at the UHWI are to compare favourably with international recommendations.
authors.affiliation: Department of Surgery, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica, West Indies. vm1chin@yahoo.com
authors.forename: V
authors.initials: V
authors.lastname: Chin
authors.forename: H E
authors.initials: HE
authors.lastname: Harding
authors.forename: I
authors.initials: I
authors.lastname: Tennant
authors.forename: D
authors.initials: D
authors.lastname: Soogrim
authors.forename: G M
authors.initials: GM
authors.lastname: Gordon-Strachan
authors.forename: M A
authors.initials: MA
authors.lastname: Frankson
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D014900:West Indies
chemical_list: D000900:Anti-Bacterial Agents