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Critical Care

, 16:R221

First Online: 15 November 2012Received: 14 July 2012Revised: 10 October 2012Accepted: 12 November 2012

Abstract

IntroductionAn online survey was conducted to characterize current infection management practices in Italian intensive care units ICUs, including the antibacterial and antifungal drug regimens prescribed for various types of infections.

MethodsDuring February and March 2011, all 450 ICUs in public hospitals in Italy were invited to take part in an online survey.
The questionnaire focused on ICU characteristics, methods used to prevent, diagnose, and treat infections, and antimicrobials prescribing policies.
The frequency of each reported practice was calculated as a percentage of the total number of units answering the question.
The overall response rate to the questionnaire was 38.8% 175 of the 450 ICUs contacted with homogeneous distribution across the country and in terms of unit type.

ResultsEighty-eight percent of the responding facilities performed periodical surveillance cultures on all patients.
In 71% of patients, cultures were also collected on admission.
Endotracheal-bronchial aspirates were the most frequently cultured specimens at both time points.
Two-thirds of the responding units had never performed screening cultures for methicillin-resistant Staphylococcus aureus.
Around 67% of the ICUs reported the use of antimicrobial de-escalation strategies during the treatment phase.
In general, the use of empirical antimicrobial drug regimens was appropriate.
Although the rationale for the choice was not always clearly documented, the use of a combination therapy was preferred over antibiotic monotherapy.
The preferred first-line agents for invasive candidiasis were fluconazole and an echinocandin 64% and 25%, respectively.
Two-thirds of the ICUs monitored vancomycin serum levels and administered it by continuous infusion in 86% of cases.
For certain antibiotics, reported doses were too low to ensure effective treatment of severe infections in critically ill patients; conversely, inappropriately high doses were administered for certain antifungal drugs.

ConclusionsAlthough infection control policies and management practices are generally appropriate in Italian ICUs, certain aspects, such as the extensive use of multidrug empirical regimens and the inappropriate antimicrobial dosing, deserve careful management and closer investigation.

AbbreviationsAUCare under the curve

CAPcommunity-acquired pneumonia

Cmaxmaximal concentration

HAPhospital-acquired pneumonia

HCAPhealth-care-associated pneumonia

ICUIntensive Care Unit

MDRmultidrug-resistant

MICminimum inhibitory concentration

MRSAmethicillin-resistant Staphylococcus aureus

PDpharmacodynamics

PKpharmacokinetics

SIAARTISocietà Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva

TDDtotal daily dose

TDMtherapeutic drug monitoring

VAPventilator-associated pneumonia.

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Autor: Matteo Bassetti - Raffaele De Gaudio - Teresita Mazzei - Giulia Morace - Nicola Petrosillo - Pierluigi Viale - Giuseppe Bel

Fuente: https://link.springer.com/



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