Characterization of antibiotic prescription in intensive care units according to the Access, Watch, and Reserve classification
DOI:
https://doi.org/10.15649/cuidarte.4340Keywords:
Antibiotic, Antibiotic Prophylaxis, Drug Prescription, Infection, Drug Resistance, MicrobialAbstract
Highlights
- A total of 37.17% of the patients received more than three antibiotics during their stay in the intensive care unit.
- Multivariate analysis revealed significant differences in diagnoses across the Access, Watch, and Reserve antibiotic classifications, with notable use of Watch antibiotics in cases of pneumonia and intra-abdominal infections.
- Beta-lactam antibiotics were administered to 99.13% of patients, indicating a predominant preference for this group of medications for infection management in intensive care units.
- Among the intensive care unit population, 10.90% of patients had chronic kidney disease requiring specialized attention for antibiotic selection and dosing to minimize nephrotoxicity.
Introduction: The inappropriate use of antibiotics in intensive care units poses risks, such as increased infections caused by multidrug-resistant bacteria and adverse reactions. The World Health Organization's strategy, named Access, Watch, and Reserve, aims to mitigate these risks by categorizing antibiotics into these categories. Objective: To characterize antibiotic consumption in the adult population of intensive care units during the first quarter of 2023. Materials and Methods: A cross-sectional study on patients in intensive care units was conducted. A bivariate and multivariate analyses with logistic regression were carried out. Results: 807 intensive care unit patients were studied, with a median age of 60 years. Piperacillin/tazobactam was the most prescribed antibiotic. According to the Access, Watch, and Reserve classification, 77.96% of prescriptions fell into Watch category, 11.29% into Reserve, and 10.75% into Access. Discussion: Antibiotic use in intensive care units is crucial for managing critically ill patients. Our study focuses on the challenges of antibiotic selection, complication management, and emphasizes antimicrobial stewardship for optimal therapy and reduced resistance. Conclusion: It is crucial to conduct an intervention study to demonstrate how increasing interaction of the antimicrobial stewardship team during prescription can enhance antibiotic use, reduce side effects, and decrease unnecessary costs.
How to cite this article: Solórzano Carlos Augusto, Manrique-Hernández Edgar Fabián, Miranda Barajas Ángela, Caro María Alejandra, Rubio María Camila, Licht-Ardila Maricel, Hurtado-Ortiz Alexandra. Characterization of antibiotic prescription in intensive care units according to the Access, Watch, and Reserve classification. Revista Cuidarte. 2025;16(2):e4340. https://doi.org/10.15649/cuidarte.4340
References
Cantón R, Horcajada JP, Oliver A, Garbajosa PR, Vila J. Inappropriate use of antibiotics in hospitals: the complex relationship between antibiotic use and antimicrobial resistance. Enferm Infecc Microbiol Clin. 2013;31(4):3-11. https://doi.org/10.1016/S0213-005X(13)70126-5
Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629-655. https://doi.org/10.1016/S0140-6736(21)02724-0
World Bank. Drug-Resistant Infections: A Threat to Our Economic Future. [Internet]. Published March 2017. [Cited 2024 March 6]. Available from: https://www.worldbank.org/en/topic/health/publication/drug-resistant-infections-a-threat-to-our-economic-future
Vargas-Alzate CA, Higuita-Gutiérrez LF, Jiménez-Quiceno JN. Direct medical costs of urinary tract infections by Gram-negative bacilli resistant to beta-lactams in a tertiary care hospital in Medellín, Colombia. Biomedica. 2019;39(s1):35-49. https://doi.org/10.7705/biomedica.v39i1.3981
Li Y, Xia X, Li X, Xiao K, Zhuang X. Correlation between the use of antibiotics and development of a resistant bacterial infection in patients in the ICU. Biosci Trends. 2018;12(5):517-519. https://doi.org/10.5582/bst.2018.01130
Özger HS, Fakıoğlu DM, Erbay K, Albayrak A, Hızel K. Inappropriate use of antibiotics effective against gram positive microorganisms despite restrictive antibiotic policies in ICUs: a prospective observational study. BMC Infect Dis. 2020;20(1):289. https://doi.org/10.1186/s12879-020-05005-7
Centers for Disease Control and Prevention. 2019 Antibiotic Resistance Threats Report. [Internet]. Updated November 14, 2023. [Cited 2024 May 27]. Available from: https://www.cdc.gov/antimicrobial-resistance/data-research/threats/index.html
Palavecino CM. Toxicidad antibacterianos: farmacocinética-farmacodinamia: prevención y manejo. Revista Médica Clínica Las Condes. 2014;25(3):445-456. https://doi.org/10.1016/S0716-8640(14)70061-6
Agencia Española de Medicamentos y Productos Sanitarios. Plan Nacional Resistencia Antibióticos (PRAN) 2022-2024. Consulta: May 15, 2024. Disponible en: https://www.resistenciaantibioticos.es/sites/default/files/2022-09/Plan%20Nacional%20Resistencia%20Antibióticos%20%28PRAN%29%202022-2024.pdf
Haque A, Hussain K, Ibrahim R, Abbas Q, Ahmed SA, Jurair H, et al. Impact of pharmacist-led antibiotic stewardship program in a PICU of low/middle-income country. BMJ Open Qual. 2018;7(1):e000180. https://doi.org/10.1136/bmjoq-2017-000180
Colombia. Instituto Nacional de Salud. Protocolo de Vigilancia en Salud Pública de Consumo de Antibióticos en el ámbito hospitalario. 2022 . Consulta: May 15, 2024. Disponible en: https://www.saludcapital.gov.co/CTDLab/Publicaciones/2023/Prot_Vig_Antibioticos.pdf
Barnsteiner S, Baty F, Albrich WC, Babouee Flury B, Gasser M, Plüss-Suard C, et al. Antimicrobial resistance and antibiotic consumption in intensive care units, Switzerland, 2009 to 2018. Euro Surveill. 2021; 26(46):2001537. https://doi.org/10.2807/1560-7917.ES.2021.26.46.2001537
World Health Organization. Global antimicrobial resistance and use surveillance system (GLASS) report [Internet] 2024. [Cited March 6, 2024]. Available from: https://iris.who.int/handle/10665/375875
The Global Health Network. AWaRe: Access, Watch, and Reserve classification of antibiotics. [Internet]. [Cited March 6, 2024]. Available from: https://amr.tghn.org/aware/
Solórzano CA, Licht-Ardila M, Manrique-Hernández EF, Miranda Barajas A, Caro MA, Rubio MC, Hurtado A. Antibiotic Prescribing Strategies in Intensive Care Units. Zenodo. 2024. https://doi.org/10.5281/zenodo.13152513
Corona A, Cattaneo D, Latronico N. Antibiotic Therapy in the Critically Ill with Acute Renal Failure and Renal Replacement Therapy: A Narrative Review. Antibiotics. 2022;11(12):1769. https://doi.org/10.3390/antibiotics11121769
Moniz P, Coelho L, Póvoa P. Antimicrobial Stewardship in the Intensive Care Unit: The Role of Biomarkers, Pharmacokinetics, and Pharmacodynamics. Adv Ther. 2021;38(1):164-179. https://doi.org/10.1007/s12325-020-01558-w
Calderwood MS, Anderson DJ, Bratzler DW, Dellinger EP, Garcia-Houchins S, Maragakis LL, et al. Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2023;44(5):695-720. https://doi.org/10.1017/ice.2023.67
Waagsbø B, Tranung M, Damås JK, Heggelund L. Antimicrobial therapy of community-acquired pneumonia during stewardship efforts and a coronavirus pandemic: an observational study. BMC Pulm Med. 2022;22(1):379. https://doi.org/10.1186/s12890-022-02178-6
Kallel H, Houcke S, Resiere D, Roy M, Mayence C, Mathien C, et al. Epidemiology and Prognosis of Intensive Care Unit-Acquired Bloodstream Infection. Am J Trop Med Hyg. 2020;103(1):508-514. https://doi.org/10.4269/ajtmh.19-0877
Ababneh MA, Al Domi M, Rababa'h AM. Antimicrobial use and mortality among intensive care unit patients with bloodstream infections: implications for stewardship programs. Heliyon. 2022;8(8):e10076. https://doi.org/10.1016/j.heliyon.2022.e10076
Zakhour J, Haddad SF, Kerbage A, Wertheim H, Tattevin P, Voss A, et al. Diagnostic stewardship in infectious diseases: a continuum of antimicrobial stewardship in the fight against antimicrobial resistance. Int J Antimicrob Agents. 2023;62(1):106816. https://doi.org/10.1016/j.ijantimicag.2023.106816
Ture Z, Güner R, Alp E. Antimicrobial stewardship in the intensive care unit. J Intensive Med. 2022;3(3):244-253. https://doi.org/10.1016/j.jointm.2022.10.001
Mokrani D, Chommeloux J, Pineton de Chambrun M, Hékimian G, Luyt CE. Antibiotic stewardship in the ICU: time to shift into overdrive. Ann Intensive Care. 2023;13(1):39. https://doi.org/10.1186/s13613-023-01134-9
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