Abstract
| Original language | English |
|---|---|
| Pages (from-to) | 65-70 |
| Number of pages | 6 |
| Journal | International Journal of Antimicrobial Agents |
| Volume | 51 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jan 1 2018 |
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Use of evidence-based recommendations in an antibiotic care bundle for the intensive care unit. / Mutters, N. T.; Angelis, G. De; Restuccia, G.; Muzio, F. Di; Schouten, J.; Hulscher, M.; Antonelli, M.; Tacconelli, E.
In: International Journal of Antimicrobial Agents, Vol. 51, No. 1, 01.01.2018, p. 65-70.Research output: Contribution to journal › Article
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TY - JOUR
T1 - Use of evidence-based recommendations in an antibiotic care bundle for the intensive care unit
AU - Mutters, N. T.
AU - Angelis, G. De
AU - Restuccia, G.
AU - Muzio, F. Di
AU - Schouten, J.
AU - Hulscher, M.
AU - Antonelli, M.
AU - Tacconelli, E.
N1 - LR: 20181202; CI: Copyright (c) 2017; JID: 9111860; 0 (Anti-Bacterial Agents); OTO: NOTNLM; 2017/03/17 00:00 [received]; 2017/06/06 00:00 [revised]; 2017/06/24 00:00 [accepted]; 2017/07/15 06:00 [pubmed]; 2018/07/28 06:00 [medline]; 2017/07/15 06:00 [entrez]; ppublish
PY - 2018/1/1
Y1 - 2018/1/1
N2 - PURPOSE: To drive decisions on antibiotic therapy in the intensive care unit (ICU), we developed an antibiotic care bundle (ABC-Bundle) with evidence-based recommendations (EBRs) for antibiotic prescriptions. METHODS: We conducted a three-step prospective study. First, a systematic review was performed of the literature reporting EBRs for antibiotic usage in the ICU. Second, we developed an ABC-Bundle through a two-round, RAND-modified Delphi method with an international expert panel, including the most relevant EBRs on a 9-point Likert scale. Those EBRs that were considered mandatory by >50% of the experts were included in the bundle. Third, we assessed the adherence to and applicability of the bundle in two mixed university ICUs. RESULTS: Out of 1190 potentially relevant articles, 14 (four guidelines, four randomised controlled trials and six systematic reviews) fulfilled the eligibility criteria. Six EBRs were classified as relevant: 1. Provide rationale for antibiotic start; 2. Perform appropriate microbiological sampling; 3. Prescribe empirical antibiotic therapy according to guidelines (Day 1); 4. Review diagnosis; 5. Evaluate de-escalation based on microbiological results (Days 2-5); and 6. Consider discontinuation of treatment (Days 3-5). Daily adherence to the ABC-Bundle, prospectively assessed in 861 days of therapy in 142 ICU patients, ranged from 2% to 37%. CONCLUSION: The ABC-Bundle is a novel tool to improve delivery of appropriate antibiotic therapy to ICU patients. The low adherence in the prospective cohorts confirms the significant role that the ABC-Bundle could play in an antibiotic stewardship programme in the ICU setting.
AB - PURPOSE: To drive decisions on antibiotic therapy in the intensive care unit (ICU), we developed an antibiotic care bundle (ABC-Bundle) with evidence-based recommendations (EBRs) for antibiotic prescriptions. METHODS: We conducted a three-step prospective study. First, a systematic review was performed of the literature reporting EBRs for antibiotic usage in the ICU. Second, we developed an ABC-Bundle through a two-round, RAND-modified Delphi method with an international expert panel, including the most relevant EBRs on a 9-point Likert scale. Those EBRs that were considered mandatory by >50% of the experts were included in the bundle. Third, we assessed the adherence to and applicability of the bundle in two mixed university ICUs. RESULTS: Out of 1190 potentially relevant articles, 14 (four guidelines, four randomised controlled trials and six systematic reviews) fulfilled the eligibility criteria. Six EBRs were classified as relevant: 1. Provide rationale for antibiotic start; 2. Perform appropriate microbiological sampling; 3. Prescribe empirical antibiotic therapy according to guidelines (Day 1); 4. Review diagnosis; 5. Evaluate de-escalation based on microbiological results (Days 2-5); and 6. Consider discontinuation of treatment (Days 3-5). Daily adherence to the ABC-Bundle, prospectively assessed in 861 days of therapy in 142 ICU patients, ranged from 2% to 37%. CONCLUSION: The ABC-Bundle is a novel tool to improve delivery of appropriate antibiotic therapy to ICU patients. The low adherence in the prospective cohorts confirms the significant role that the ABC-Bundle could play in an antibiotic stewardship programme in the ICU setting.
U2 - S0924-8579(17)30269-8 [pii]
DO - S0924-8579(17)30269-8 [pii]
M3 - Article
VL - 51
SP - 65
EP - 70
JO - International Journal of Antimicrobial Agents
JF - International Journal of Antimicrobial Agents
SN - 0924-8579
IS - 1
ER -