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. 2021 Apr 15;8(7):ofab182.
doi: 10.1093/ofid/ofab182. eCollection 2021 Jul.

Evaluation of Clinical Outcomes After Introduction of a Dedicated Infectious Diseases-Critical Care Medicine Service in Critical Care Units

Polina Trachuk  1   2 , Vagish Hemmige  3 , Ruth Eisenberg  4 , Kelsie Cowman  3 , Victor Chen  5 , Gregory Weston  3 , Inessa Gendlina  3 , Nadia Ferguson  5 , Peter Dicpinigaitis  6 , Jay Berger  6   7 , Liise-Anne Pirofski  3 , Uzma N Sarwar  3
Affiliations

Evaluation of Clinical Outcomes After Introduction of a Dedicated Infectious Diseases-Critical Care Medicine Service in Critical Care Units

Polina Trachuk et al. Open Forum Infect Dis. .

Abstract

Background: Infection is a leading cause of admission to intensive care units (ICUs), with critically ill patients often receiving empiric broad-spectrum antibiotics. Nevertheless, a dedicated infectious diseases (ID) consultation and stewardship team is not routinely established. An ID-critical care medicine (ID-CCM) pilot program was designed at a 400-bed tertiary care hospital in which an ID attending was assigned to participate in daily rounds with the ICU team, as well as provide ID consultation on select patients. We sought to evaluate the impact of this dedicated ID program on antibiotic utilization and clinical outcomes in patients admitted to the ICU.

Methods: In this single-site retrospective study, we analyzed antibiotic utilization and clinical outcomes in patients admitted to an ICU during the postintervention period from January 1 to December 31, 2017, and compared it to antibiotic utilization in the same ICUs during the preintervention period from January 1 to December 31, 2015.

Results: Our data showed a statistically significant reduction in usage of most frequently prescribed antibiotics including vancomycin, piperacillin-tazobactam, and cefepime during the intervention period. When compared to the preintervention period there was no difference in-hospital mortality, hospital length of stay, and readmission.

Conclusions: With this multidisciplinary intervention, we saw a decrease in the use of the most frequently prescribed broad-spectrum antibiotics without a negative impact on clinical outcomes. Our study shows that the implementation of an ID-CCM service is a feasible way to promote antibiotic stewardship in the ICU and can be used as a strategy to reduce unnecessary patient exposure to broad-spectrum agents.

Keywords: antibiotic stewardship; critical care; infectious diseases; intensive care unit.

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Figures

Figure 1.
Figure 1.
Antibiotic utilization rates of most frequently used broad-spectrum agents pre- and postintervention. *Statistically significant, P value calculated using Poisson regression analysis. Abbreviation: DOT, days of therapy.
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