A survey on infection management practices in Italian ICUs
1 Infectious Diseases Department, Santa Maria Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
2 Department of Critical Care, Anesthesiology and Intensive Care Section, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
3 Department of Preclinical and Clinical Pharmacology, University of Florence, Via delle Oblate 1, 50141 Firenze, Italy
4 Department of Public Health, Microbiology, Virology, University of Milan, Via Pascal, 36, 20133 Milano, Italy
5 Second Division for Infectious Diseases, Lazzaro Spallanzani National Institute for Infectious Diseases, Via Portuense 292, 00149 Roma, Italy
6 Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
7 Department of Intensive Care and Anesthesiology, Agostino Gemelli Medical Center, Catholic University of the Sacred Heart, Largo Agostino Gemelli 8, 00168 Roma, Italy
8 Anti-infective and Transplant Team, Specialty Care Medical Affairs, Pfizer Italia S.r.l., Via Valbondione, 113, 00188 Roma, Italy
Critical Care 2012, 16:R221 doi:10.1186/cc11866Published: 15 November 2012
An online survey was conducted to characterize current infection management practices in Italian intensive care units (ICUs), including the antibacterial and antifungal drug regimens prescribed for various types of infections.
During February and March 2011, all 450 ICUs in public hospitals in Italy were invited to take part in an online survey. The questionnaire focused on ICU characteristics, methods used to prevent, diagnose, and treat infections, and antimicrobials prescribing policies. The frequency of each reported practice was calculated as a percentage of the total number of units answering the question. The overall response rate to the questionnaire was 38.8% (175 of the 450 ICUs contacted) with homogeneous distribution across the country and in terms of unit type.
Eighty-eight percent of the responding facilities performed periodical surveillance cultures on all patients. In 71% of patients, cultures were also collected on admission. Endotracheal/bronchial aspirates were the most frequently cultured specimens at both time points. Two-thirds of the responding units had never performed screening cultures for methicillin-resistant Staphylococcus aureus. Around 67% of the ICUs reported the use of antimicrobial de-escalation strategies during the treatment phase. In general, the use of empirical antimicrobial drug regimens was appropriate. Although the rationale for the choice was not always clearly documented, the use of a combination therapy was preferred over antibiotic monotherapy. The preferred first-line agents for invasive candidiasis were fluconazole and an echinocandin (64% and 25%, respectively). Two-thirds of the ICUs monitored vancomycin serum levels and administered it by continuous infusion in 86% of cases. For certain antibiotics, reported doses were too low to ensure effective treatment of severe infections in critically ill patients; conversely, inappropriately high doses were administered for certain antifungal drugs.
Although infection control policies and management practices are generally appropriate in Italian ICUs, certain aspects, such as the extensive use of multidrug empirical regimens and the inappropriate antimicrobial dosing, deserve careful management and closer investigation.