Effects of a comprehensive antimicrobial stewardship program in a surgical intensive care unit

Highlights

• Antibiotics stewardship program (ASP) in the surgical ICU was implemented.

• Comprehensive ASP decreased the use of anti-pseudomonal beta-lactams.

• Susceptibilities of anti-pseudomonal beta-lactams were improved during ASP period.

• Comprehensive ASP was a factor associated with decreased mortality in surgical ICU.

• ASP should be implemented to improve antimicrobial use and patient outcome.

Abstract

Objectives

We evaluated the effects of a comprehensive antimicrobial stewardship program (ASP) in a surgical intensive care unit (SICU).

Methods

The ASP was implemented from March 2018 to February 2019 at an SICU in a teaching hospital. An infectious disease physician and a pharmacist visited the SICU 3 times per week for prospective audit and feedback. Outcomes were compared between the ASP period and the same months in the preceding year (pre-ASP period). The primary outcome measure was the use of anti-pseudomonal beta-lactams (APBL). Appropriate antimicrobial de-escalation and ICU mortality rates were also compared.

Results

A total of 182 and 149 patients were included in the study for the pre-ASP and ASP periods, respectively. Although disease severity was higher in the ASP group (septic shock 39.0% in pre-ASP vs 65.1% in ASP group, P < 0.001), the use of APBL as a definitive treatment was lower during ASP (68.7% vs 57.7%, OR 0.62, 95% CI 0.40–0.98). Appropriate antimicrobial de-escalation improved (63.2% vs 94.6%, P < 0.001). ICU mortality was comparable (7.7% vs 7.4%) and significantly lower during the ASP, after adjustment (adjusted OR 0.41, 95% CI 0.18–0.92, P = 0.032).

Conclusions

A comprehensive ASP decreased the use of APBL and was associated with improved patient outcomes.