title: A Multicenter Evaluation of Prolonged Empiric Antibiotic Therapy in Adult ICUs in the United States.
abstract: OBJECTIVE
  The purpose of this study is to determine the rate of prolonged empiric antibiotic therapy in adult ICUs in the United States. Our secondary objective is to examine the relationship between the prolonged empiric antibiotic therapy rate and certain ICU characteristics.
  
  
  METHODS
  Multicenter, prospective, observational, 72-hour snapshot study.
  
  
  METHODS
  Sixty-seven ICUs from 32 hospitals in the United States.
  
  
  METHODS
  Nine hundred ninety-eight patients admitted to the ICU between midnight on June 20, 2011, and June 21, 2011, were included in the study.
  
  
  METHODS
  None.
  
  
  RESULTS
  Antibiotic orders were categorized as prophylactic, definitive, empiric, or prolonged empiric antibiotic therapy. Prolonged empiric antibiotic therapy was defined as empiric antibiotics that continued for at least 72 hours in the absence of adjudicated infection. Standard definitions from the Centers for Disease Control and Prevention were used to determine infection. Prolonged empiric antibiotic therapy rate was determined as the ratio of the total number of empiric antibiotics continued for at least 72 hours divided by the total number of empiric antibiotics. Univariate analysis of factors associated with the ICU prolonged empiric antibiotic therapy rate was conducted using Student t test. A total of 660 unique antibiotics were prescribed as empiric therapy to 364 patients. Of the empiric antibiotics, 333 of 660 (50%) were continued for at least 72 hours in instances where Centers for Disease Control and Prevention infection criteria were not met. Suspected pneumonia accounted for approximately 60% of empiric antibiotic use. The most frequently prescribed empiric antibiotics were vancomycin and piperacillin/tazobactam. ICUs that utilized invasive techniques for the diagnosis of ventilator-associated pneumonia had lower rates of prolonged empiric antibiotic therapy than those that did not, 45.1% versus 59.5% (p = 0.03). No other institutional factor was significantly associated with prolonged empiric antibiotic therapy rate.
  
  
  CONCLUSIONS
  Half of all empiric antibiotics ordered in critically ill patients are continued for at least 72 hours in absence of adjudicated infection. Additional studies are needed to confirm these findings and determine the risks and benefits of prolonged empiric therapy in the critically ill.
authors.affiliation: 1Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscatway, NJ. 2Department of Pharmacy, Hackensack University Medical Center, Hackensack, NJ 3Department of Pharmacy, Saint Peter's University Hospital, New Brunswick, NJ. 4Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE. 5Department of Pharmacy Practice, School of Pharmacy, University of Connecticut/Hartford Hospital, Hartford, CT. 6Information and Technology Services, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Zachariah
authors.initials: Z
authors.lastname: Thomas
authors.forename: Farooq
authors.initials: F
authors.lastname: Bandali
authors.forename: Jayashri
authors.initials: J
authors.lastname: Sankaranarayanan
authors.forename: Tom
authors.initials: T
authors.lastname: Reardon
authors.forename: Keith M
authors.initials: KM
authors.lastname: Olsen
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D016638:Critical Illness; D004334:Drug Administration Schedule; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents