Provision of Microbiology, Infection Services and Antimicrobial Stewardship in Intensive Care: A Survey across the Critical Care Networks in England and Wales

Abstract

Infection rounds in Intensive Care Units (ICU) can impact antimicrobial stewardship (AMS). The aim of this survey was to assess the availability of microbiology, infection, AMS services, and antimicrobial prescribing practices in the UK ICUs. An online questionnaire was sent to clinical leads for ICUs in each region listed in the Critical Care Network for the UK. Out of 217 ICUs, 87 deduplicated responses from England and Wales were analyzed. Three-quarters of those who responded had a dedicated microbiologist, and 50% had a dedicated infection control prevention nurse. Infection rounds varied in their frequency, with 10% providing phone advice only. Antibiotic guidance was available in 99% of the units; only 8% of those were ICU-specific. There were variations in the availability of biomarkers & the duration of antibiotics prescribed for pneumonia (community, hospital, or ventilator), urinary, intra-abdominal, and line infections/sepsis. Antibiotic consumption data were not routinely discussed in a multi-disciplinary meeting. The electronic prescription was available in ~60% and local antibiotic surveillance data in only 47% of ICUs. The survey highlights variations in practice and AMS services and may offer the opportunity to further collaborations and share learnings to support the safe use of antimicrobials in the ICU.

Keywords: antibiotic; antibiotic stewardship; diagnostics; infection; intensive care unit.

Figure 1

The responses for the use of antimicrobial guidance (A), the accessibility to local bacterial epidemiology data (B), the presence of a dedicated infection prevention nurse (C), and the frequency of specialist ward rounds (D). * 3.5% highlighted using all forms of guidance along with microbiology-led recommendations. ** Nearly 7% of comments highlighted the use of link nurses between ICU and infection control nurses available to the wider hospital rather than specifically dedicated to ICU; *** Circa 20% included once weekly 5 days a week and weekends by phone, telephone ward rounds mostly weekdays, a mixture of virtual and MDT ward rounds. Comments noted the use of Microsoft Teams as a platform used to complete multidisciplinary ward rounds. There were no responses highlighting no access to microbiology or infectious diseases services.

Figure 2

Routine access to biomarkers and rapid molecular diagnostics. CRP: C-reactive protein. PCT: Procalcitonin. IL6: Interleukin 6. TNF-alpha: (tumor necrosis factor-alpha). PCR: Rapid molecular PCR—for single or multiple respiratory pathogens.