Antimicrobial use and microbiological testing in district general hospital ICUs of the Veneto region of north-east Italy.
International - predominantly American - studies undertaken in the ICUs of teaching centres show that inadequate antibiotic therapy increases mortality and length of stay. We sought to ascertain whether this also pertains to smaller ICUs in the Veneto region of north-east Italy. To the best of our knowledge, this is the first such survey in the Veneto area or in Italy as a whole. A retrospective, observational study was performed across five general-hospital ICUs to examine appropriateness of microbiological sampling, empirical antibiotic adequacy, and outcomes. Among 911 patients (mean age, 65.8 years ± 16.2 SD; median ICU stay, 17.0 days [IQR, 8.0-29.0]), 757 (83.1 %) were given empirical antibiotics. Treatment adequacy could be fully assessed in only 212 patients (28.0 %), who received empirical treatment and who had a relevant clinical sample collected at the initiation of this antibiotic (T0). Many other patients only had delayed microbiological investigation of their infections between day 1 and day 10 of therapy. Mortality was significantly higher among the 34.9 % of patients receiving inadequate treatment (48.6 % vs 18.80 %; p < 0.001). Only 32.5 % of combination regimens comprised a broad-spectrum Gram-negative β-lactam plus an anti-MRSA agent, and many combinations were irrational. Inadequate treatment was frequent and was strongly associated with mortality; moreover, there was delayed microbiological investigation of many infections, precluding appropriate treatment modification and de-escalation. Improvements in these aspects and in antibiotic stewardship are being sought.
Unità Operativa di Malattie Infettive e Tropicali, Ospedale San Bortolo, Viale Rodolfi 37, 36100, Vicenza, Italy. paolo.benedetti@ulssvicenza.it.
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Benedetti
Institute of Cell and Molecular Science, Centre for Infectious Disease, Barts and the London School of Medicine and Dentistry, 4 Newark Street, London, E1 2AT, UK.
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Sefton
Laboratorio di Microbiologia, Ospedale San Bortolo, Viale Rodolfi 37, 36100, Vicenza, Italy.
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Menegozzo
Laboratorio di analisi chimico-cliniche e microbiologiche, Nuovo Ospedale Santorso, Via delle Garziere 42, 36014, Santorso, Italy.
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Guerriero
Laboratorio di analisi chimico-cliniche e microbiologiche, Ospedale San Giacomo Apostolo, Via dei Carpani 16/Z, 31033, Castelfranco, Veneto, Italy.
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Bordignon
Medicina di laboratorio, Ospedale San Bassiano, Via dei Lotti 40, 36061, Bassano del Grappa, Italy.
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Da Rin
Servizio di Statistica, Dipartimento di Biologia, Università degli studi di Padova, Via Ugo Bassi 58/B, 35121, Padova, Italy.
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Romualdi
Unità Operativa di Malattie Infettive e Tropicali, Ospedale San Bortolo, Viale Rodolfi 37, 36100, Vicenza, Italy.
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Pellizzer
Norwich Medical School, University of East Anglia, Norwich Research Park, NR4 7TJ, Norwich, UK.
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Livermore
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006769:Hospitals, General; D006801:Humans; D007362:Intensive Care Units; D007558:Italy; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
D000890:Anti-Infective Agents