Most Important Factors Driving Usage of Antibiotics in the ICU

The most important factors that influence antibiotic selection in the intensive care unit (ICU) setting are an agent’s availability in intravenous (IV) formulation, activity against Pseudomonas and extended-spectrum beta lactamase producing pathogens and drug-drug-interactions, according to Arlington Medical Resources (AMR) and Decision Resources.

The achievement of rapid therapeutic concentration is often necessary in this hospital setting and many critically ill patients cannot be given oral antibiotics. Other important attributes include bactericidal activity. However, attributes such as anti-methicillin-resistant Staphylococcus aureus (MRSA) activity and a low propensity to induce resistance are important across all hospital settings.

“Patients in the ICU setting tend to be significantly sicker and more debilitated than patients in general wards. The infections they suffer are often more severe and they often have underlying conditions that can complicate treatment. Therefore, factors influencing antibiotic selection and prescribing dynamics in the ICU setting differ from the broader hospital ward settings,” stated John Lebbos, MD, vice president of infectious diseases at Decision Resources.

The report entitled Hospital Anti-Infectives Insight Series: Antibiotic Usage Patterns and Drivers of Prescribing in the ICU Setting also finds that in many hospitals, the ICU setting has a lower level of use restrictions than the general wards. This reflects the need for physicians practicing in the ICU to prescribe highly potent antibiotics. Nearly 25 percent of surveyed physicians state that the level of restrictions placed on antibiotics in the ICU setting is lower than that in general wards and an additional 24 percent of surveyed physicians indicate that no restrictions are placed on antibiotics in the ICU setting.