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Antibiotic prophylaxis in the ICU: to be or not to be administered for patients undergoing procedures?

  • Ignacio Martin-LoechesEmail author
  • Marc Leone
  • Sharon Einav
What's New in Intensive Care
Part of the following topical collections:
  1. Severe infections in the critically ill

Critically ill patients receive antimicrobials for multiple reasons. Antimicrobials may be prescribed as perioperative “prophylaxis” when an intensive care unit (ICU) patient is transferred to the operation room. Such practice is intended to ensure bactericidal serum antibiotic concentrations at the time of surgical incision, as accepted in non-ICU patients. At other times, “prophylactic” antibiotic administration is driven by concerns regarding the tolerance of fragile patients to bacteremia, even when transient [1, 2], and the high likelihood of patient exposure to multiple environmental contaminants [3].

However, administration of unnecessary prophylactic antimicrobial therapy comes at a price; clinicians are often reluctant to stop antimicrobial therapy once it has been initiated, regardless of the appropriateness of treatment [4]. A study conducted in 281 Australian hospitals found that 40% of > 20,000 antibiotics prescribed in hospital wards were inappropriate, mainly due to...

Notes

Acknowledgements

The work was funded by JPIAMR (Grant No. 2018-06335).

Compliance with ethical standards

Conflicts of interest

IML received from MSD, Gilead for lectures and Aguettant for consulting. ML received fees from 3M, Aspen, Edwards, MSD, Octopharma, Orion, Pfizer for lectures and Aguettant, Amomed for consulting. SE have no conflicts of interest.

Supplementary material

134_2019_5870_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 14 kb)
134_2019_5870_MOESM2_ESM.docx (19 kb)
Supplementary material 2 (DOCX 18 kb)

References

  1. 1.
    Kang C-I, Kim S-H, Park WB et al (2005) Bloodstream infections caused by antibiotic-resistant gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome. Antimicrob Agents Chemother 49:760–766.  https://doi.org/10.1128/AAC.49.2.760-766 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Ibrahim EH, Sherman G, Ward S et al (2000) The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 118:146–155.  https://doi.org/10.1378/chest.118.1.146 CrossRefPubMedGoogle Scholar
  3. 3.
    Russotto V, Cortegiani A, Raineri SM, Giarratano A (2015) Bacterial contamination of inanimate surfaces and equipment in the intensive care unit. J Intensive Care 3:54.  https://doi.org/10.1186/s40560-015-0120-5 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Leekha S, Terrell CL, Edson RS (2011) General principles of antimicrobial therapy. Mayo Clin Proc 86:156–167.  https://doi.org/10.4065/mcp.2010.0639 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
  6. 6.
    Ruiz-Ramos J, Frasquet J, Romá E et al (2017) Cost-effectiveness analysis of implementing an antimicrobial stewardship program in critical care units. J Med Econ 20:652–659.  https://doi.org/10.1080/13696998.2017.1311903 CrossRefPubMedGoogle Scholar
  7. 7.
    Seekatz AM, Young VB (2014) Clostridium difficile and the microbiota. J Clin Invest 124:4182–4189.  https://doi.org/10.1172/JCI72336 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Daneman N, Sarwar S, Fowler RA et al (2013) Effect of selective decontamination on antimicrobial resistance in intensive care units: a systematic review and meta-analysis. Lancet Infect Dis 13:328–341.  https://doi.org/10.1016/S1473-3099(12)70322-5 CrossRefPubMedGoogle Scholar
  9. 9.
    Plachouras D, Kärki T, Hansen S et al (2018) Antimicrobial use in European acute care hospitals: results from the second point prevalence survey (PPS) of healthcare-associated infections and antimicrobial use, 2016 to 2017. Euro Surveill.  https://doi.org/10.2807/1560-7917.ES.23.46.1800393 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Martin-Loeches I, Antonelli M, Cuenca-Estrella M et al (2019) ESICM/ESCMID task force on practical management of invasive candidiasis in critically ill patients. Intensive Care Med 45:789–805.  https://doi.org/10.1007/s00134-019-05599-w CrossRefPubMedGoogle Scholar
  11. 11.
    Weber WP, Mujagic E, Zwahlen M et al (2017) Timing of surgical antimicrobial prophylaxis: a phase 3 randomised controlled trial. Lancet Infect Dis 17:605–614.  https://doi.org/10.1016/S1473-3099(17)30176-7 CrossRefPubMedGoogle Scholar
  12. 12.
    Martin C, Auboyer C, Boisson M et al (2019) Antibioprophylaxis in surgery and interventional medicine (adult patients). Update 2017. Anaesth Crit Care Pain Med 38:549–562.  https://doi.org/10.1016/j.accpm.2019.02.017 CrossRefPubMedGoogle Scholar
  13. 13.
    De Bus L, Gadeyne B, Steen J et al (2018) A complete and multifaceted overview of antibiotic use and infection diagnosis in the intensive care unit: results from a prospective four-year registration. Crit Care 22:241.  https://doi.org/10.1186/s13054-018-2178-7 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Ohnuma T, Hayashi Y, Yamashita K et al (2018) A nationwide survey of intravenous antimicrobial use in intensive care units in Japan. Int J Antimicrob Agents 51:636–641.  https://doi.org/10.1016/j.ijantimicag.2018.01.022 CrossRefPubMedGoogle Scholar
  15. 15.
    Bratzler DW, Dellinger EP, Olsen KM et al (2013) Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 14:73–156.  https://doi.org/10.1089/sur.2013.9999 CrossRefGoogle Scholar
  16. 16.
    Masse J, Elkalioubie A, Blazejewski C et al (2017) Colonization pressure as a risk factor of ICU-acquired multidrug resistant bacteria: a prospective observational study. Eur J Clin Microbiol Infect Dis 36:797–805.  https://doi.org/10.1007/s10096-016-2863-x CrossRefPubMedGoogle Scholar
  17. 17.
    Nseir S, Grailles G, Soury-Lavergne A et al (2010) Accuracy of American Thoracic Society/Infectious Diseases Society of America criteria in predicting infection or colonization with multidrug-resistant bacteria at intensive-care unit admission. Clin Microbiol Infect 16:902–908.  https://doi.org/10.1111/j.1469-0691.2009.03027.x CrossRefPubMedGoogle Scholar
  18. 18.
    Einav S, Wiener-Well Y (2017) Anesthesia in patients with infectious disease caused by multi-drug resistant bacteria. Curr Opin Anaesthesiol 30:426–434.  https://doi.org/10.1097/ACO.0000000000000457 CrossRefPubMedGoogle Scholar
  19. 19.
    Duclos G, Pastene B, Depeyre F et al (2018) Surgical antimicrobial prophylaxis in intensive care unit (ICU) patients: a preliminary, observational, retrospective study. Ann Transl Med 6:402.  https://doi.org/10.21037/atm.2018.09.56 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Kalil AC, Metersky ML, Klompas M et al (2016) Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 63:e61–e111.  https://doi.org/10.1093/cid/ciw353 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Torres A, Niederman MS, Chastre J et al (2017) International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia. Eur Respir J.  https://doi.org/10.1183/13993003.00582-2017 CrossRefPubMedGoogle Scholar
  22. 22.
    Leone M, Bouadma L, Bouhemad B et al (2018) Hospital-acquired pneumonia in ICU. Anaesth Crit Care Pain Med 37:83–98.  https://doi.org/10.1016/j.accpm.2017.11.006 CrossRefPubMedGoogle Scholar
  23. 23.
    Sirvent JM, Torres A, El-Ebiary M et al (1997) Protective effect of intravenously administered cefuroxime against nosocomial pneumonia in patients with structural coma. Am J Respir Crit Care Med 155:1729–1734CrossRefGoogle Scholar
  24. 24.
    Acquarolo A, Urli T, Perone G, Giannotti C et al (2005) Antibiotic prophylaxis of early onset pneumonia in critically ill comatose patients. A randomized study. Intensive Care Med 31:510–516CrossRefGoogle Scholar
  25. 25.
    Vallés J, Peredo R, Burguenõ MJ et al (2013) Efficacy of single-dose antibiotic against early-onset pneumonia in comatose patients who are ventilatedpreventing pneumonia in comatose patients. Chest 143:1219–1225.  https://doi.org/10.1378/chest.12-1361 CrossRefPubMedGoogle Scholar
  26. 26.
    Righy C, do Brasil PEA, Vallés J et al (2017) Systemic antibiotics for preventing ventilator-associated pneumonia in comatose patients: a systematic review and meta-analysis. Ann Intensive Care 7:67.  https://doi.org/10.1186/s13613-017-0291-4 CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Dahyot-Fizelier C, Frasca D, Lasocki S et al (2018) Prevention of early ventilation-acquired pneumonia (VAP) in comatose brain-injured patients by a single dose of ceftriaxone: PROPHY-VAP study protocol, a multicentre, randomised, double-blind, placebo-controlled trial. BMJ Open 8:e021488.  https://doi.org/10.1136/bmjopen-2018-021488 CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Bosman A, de Jong MB, Debeij J et al (2012) Systematic review and meta-analysis of antibiotic prophylaxis to prevent infections from chest drains in blunt and penetrating thoracic injuries. Br J Surg 99:506–513.  https://doi.org/10.1002/bjs.7744 CrossRefPubMedGoogle Scholar
  29. 29.
    Oxman DA, Issa NC, Marty FM et al (2013) Postoperative antibacterial prophylaxis for the prevention of infectious complications associated with tube thoracostomy in patients undergoing elective general thoracic surgery: a double-blind, placebo-controlled, randomized trial. JAMA Surg 148:440–446CrossRefGoogle Scholar
  30. 30.
    Fried HI, Nathan BR, Rowe AS et al (2016) The insertion and management of external ventricular drains: an evidence-based consensus statement: a statement for healthcare professionals from the Neurocritical Care Society. Neurocrit Care 24:61–81.  https://doi.org/10.1007/s12028-015-0224-8 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s HospitalDublin 8Ireland
  2. 2.Respiratory Institute, Pulmonary Intensive Care UnitHospital Clinic of Barcelona, IDIBAPSBarcelonaSpain
  3. 3.Department of Anesthesiology and Intensive Care Medicine, Assistance Publique Hôpitaux de Marseille, Nord HospitalAix-Marseille UniversitéMarseilleFrance
  4. 4.General Intensive Care Unit, Shaare Zedek Medical Centre, Faculty of MedicineHebrew UniversityJerusalemIsrael

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