Cost and morbidity associated with antibiotic prophylaxis in the ICU

BACKGROUND: Although the high cost and inappropriate use of antibiotics have been documented before, we are not aware of any data on nonsurgical site infectious morbidity associated with prolonged courses of prophylactic antibiotics (PA). STUDY DESIGN: Data regarding antibiotic orders were collected using a custom designed microbiology database in the Surgical Intensive Care Unit of a teaching hospital from October 1, 1995 through April 30, 1997. The database was retrospectively reviewed. The cost of PA in excess of 1 day was calculated. Frequency of bacteremia and line infections were compared in patients receiving 1 day or less of PA versus more than 4 days of PA. RESULTS: Sixty-one percent of PA orders were continued for more than 1 day. Cost of PA beyond 1 day totaled 44, 893. Bacteremia and line infection were more frequent in the patients receiving more than 4 days of PA. CONCLUSIONS: There was poor compliance with the protocol of stopping PA at 24 hours. The cost of noncompliance was 44, 893. There were more bacteremias and line infections in patients with duration of PA of more than 4 days.