Does high antibiotic consumption still reflect bad practices

Abstract Objective The authors had for aim to assess the quality of antibiotic prescription in an intensive care unit because of their high rate of consumption. Design A prospective 5-month study was made of the first 50 prescriptions of ciprofloxacin, levofloxacin, teicoplanin, vancomycin, and imipenem. Treatment was considered adequate at day 5 if the indication was relevant, with the right doses, and if the prescription was adapted to the antibiogram. Results Fifty treatments were evaluated (38 patients included). Eighty-four percent (42/50) was adequate at day 5. Glycopeptides and fluoroquinolones accounted for 2/3 of prescriptions. The absence of de-escalation was the most common mistake. The severity of presentations was evident with a mean SSI at 68 (22–113), and a mean BMI at 28 (18.5 – 50). Eighty-four percent (32/38) of patients were exposed to invasive devices, 47% died in the ICU. Discussion Most prescriptions were adequate. The patient profile could explain the high rate of antibiotic consumption. Bacteriological monitoring revealed an increased prevalence of resistant bacteria, which could explain a high rate of consumption along with adaptation of the dose to overweight. De-escalation, using aminosides more frequently, and shorter prescribed courses of fluoroquinolones should improve consumption rates does not always reflect bad practices, but may be adequate when considering bacterial ecology and patient profile.