Addition of ID specialist reduces use of broad-spectrum antibiotics in ICU
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The addition of an infectious diseases specialist to the critical care team at a New York hospital led to a decrease in the use of commonly prescribed broad-spectrum antibiotics without negatively impacting patient care, according to a study.
“Infection is a leading cause of admissions to the ICU, and even though cases of infection are the majority of admissions to the ICU, a dedicated infectious disease consultation and stewardship team is not routinely implemented,” Uzma N. Sarwar, MD, associate professor in the division of infectious diseases at the Albert Einstein College of Medicine at Montefiore Medical Center, told Healio.
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Sarwar and colleagues designed a hybrid ID consultation and stewardship program in collaboration with the hospital’s critical care medicine division and evaluated the effect of regular ID consultation on antibiotic use and clinical outcomes in patients. As part of the pilot program, “an ID attending was assigned to participate in daily rounds with the ICU team, as well as provide ID consultation on select patients,” Sarwar and colleagues wrote.
The single-site retrospective study included patients admitted to the ICU in 2017. According to the study, the researchers compared the outcomes during this time with antibiotic use in the same ICU in 2015. A total of 3,496 patients were included in the study 1,766 in the intervention group and 1,730 in the control group.
They included the six most commonly used broad-spectrum antibiotics cefepime, daptomycin, linezolid, meropenem, piperacillin-tazobactam and vancomycin in the final analysis.
According to the study, during the intervention period, there were statistically significant reductions in days of therapy for cefepime (131 vs. 101 days of therapy [DOT] per 1,000 patient days; P = .01), piperacillin-tazobactam (268 vs. 251 DOT per 1,000 patient days; P = .02) and IV vancomycin (265 vs. 228 DOT per 1,000 patient days; P = .01). The use of other antibiotics, including daptomycin, linezolid and meropenem, did not differ significantly.
There also were statistically significant reductions in courses of antibiotic therapy (COT) for cefepime (131 vs. 101 COT per 1,000 patient days; P = .002) and IV vancomycin (265 vs. 229 COT per 1,000 patient days; P = .005).
Additionally, the study demonstrated that there was no difference in the 30-day, in-hospital mortality rate between the two groups (13.7% vs, 14.1%; P = .73). Of the patients discharged, there was no difference in median length of hospital stay (8 days vs. 8 days; P = .94) or 30-day readmission rate (17.4% vs. 17.8%; P = .78).
“Our approach of incorporating a dedicated ID-critical care medicine service proved to be a feasible way of promoting antibiotic stewardship in the ICU and can be used as a strategy to reduce unnecessary patient exposure to broad-spectrum agents,” Sarwar said. “Although it was a time-intensive intervention, the incorporation of an ID specialist is a worthwhile approach that can be implemented across many institutions and it can make a meaningful impact on antibiotic utilization. Most importantly, despite the decrease in use of broad-spectrum antibiotics, our study showed no harm to patient care.”
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