The addition of an ID specialist reduces the use of broad spectrum antibiotics in the intensive care unit

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The addition of an infectious disease specialist to the intensive care team at a New York hospital resulted in a reduction in the use of commonly prescribed broad spectrum antibiotics without negatively impacting patient care, according to one study.

“Infection is a major contributor to ICU admissions, and while cases of infection make up the majority of ICU admissions, a dedicated infectious disease advisory and stewardship team is not routinely deployed.” Uzma N. Sarwar, MD, Healio said, an associate professor in the Infectious Disease Department at Albert Einstein College of Medicine at Montefiore Medical Center.

Following the introduction of an antibiotic stewardship program combined with an infectious disease consultation, the prescription of commonly used antibiotics decreased.
Photo credit: Adobe Stock.

Sarwar and colleagues worked with the hospital’s intensive care unit to develop a hybrid ID consultation and stewardship program, evaluating the impact of regular ID consultation on antibiotic use and clinical outcomes in patients. As part of the pilot program, “an ID participant was assigned to take part in daily rounds with the ICU team and offer ID counseling on selected patients,” wrote Sarwar and colleagues.

The retrospective single-site study included patients admitted to the intensive care unit in 2017. According to the study, researchers compared the results during that time with antibiotic use in the same intensive care unit in 2015. A total of 3,496 patients were enrolled in the intervention group and 1,730 in the control group.

Uzma N. Sarwar

They ultimately included the six most widely used broad spectrum antibiotics cefepime, daptomycin, linezolid, meropenem, piperacillin-tazobactam and vancomycin.

According to the study, there were statistically significant reductions in therapy days for cefepime during the intervention period (131 vs. 101 therapy days) [DOT] per 1,000 patient days; P = 0.01), piperacillin-tazobactam (268 vs. 251 DOT per 1,000 patient days; P = 0.02) and IV vancomycin (265 vs. 228 DOT per 1,000 patient days; P = 0.01). The use of other antibiotics, including daptomycin, linezolid, and meropenem, did not differ significantly.

There were also statistically significant reductions in antibiotic therapy (COT) for cefepime (131 vs. 101 COT per 1,000 patient days; P = 0.002) and IV vancomycin (265 vs. 229 COT per 1,000 patient days; P = 0.005)).

In addition, the study showed that there was no difference in the 30-day in-hospital mortality rate between the two groups (13.7% versus 14.1%; P = 0.73). Of the discharged patients, there was no difference in the mean length of hospital stay (8 days versus 8 days; P = 0.94) or the 30-day readmission rate (17.4% versus 17.8%; P = 0.78 ).

“Our approach to setting up a dedicated ID critical care medical service has proven to be a viable way of promoting antibiotic control in the intensive care unit and can be used as a strategy to reduce unnecessary patient exposure to broad spectrum drugs,” said Sarwar. “Although it was a time-consuming intervention, involving an ID specialist is a worthwhile approach that can be implemented in many institutions and that can have a significant impact on antibiotic use. Above all, our study showed no harm to patient care despite the lower use of broad spectrum antibiotics. “

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