Antibiotic prescribing appropriateness among critically ill patients at a single tertiary care center in the United Arab Emirates: a retrospective cohort study

Objective Despite expanding antimicrobial stewardship initiatives, evidence evaluating the appropriateness of antibiotic prescribing and its clinical implications in intensive care settings in the United Arab Emirates remains limited. This study aimed to assess the appropriateness of antibiotic prescribing among intensive care unit patients, identify factors associated with appropriate antibiotic therapy, and examine its association with clinical outcomes. Method A retrospective cohort study was conducted in the intensive care unit of a tertiary care hospital in the Emirate of Abu Dhabi. Adult patients aged 18 years or older who were admitted between January 2023 and December 2024, had a length of stay exceeding 24 h but less than 30 days, received at least one systemic antibiotic, and had complete medical records were included. Data were extracted from electronic medical records and a regional health information exchange platform. Antibiotic appropriateness was evaluated against institutional or Infectious Diseases Society of America guidelines. Results Overall, 36% of patients received inappropriate antibiotic therapy. The most common reason for inappropriateness was the absence of a clear indication, particularly for postoperative prophylaxis (44.4%). At the individual agent level, cefepime (48.2%), metronidazole (36.2%), and cefazolin (33.9%) exhibited the highest rates of inappropriate use. Multivariable logistic regression identified positive microbiological culture results (AOR = 3.34, p < 0.001) and sepsis (AOR = 2.12, p = 0.002) as factors independently associated with higher odds of appropriate antibiotic use. Conversely, the presence of a central venous catheter (AOR = 0.30, p = 0.003) was associated with lower odds of appropriate antibiotic use. Appropriate antibiotic therapy was associated with higher odds of organ dysfunction (AOR = 1.69, p = 0.032), nosocomial infection (AOR = 2.28, p = 0.005), and persistent infection despite therapy (AOR = 2.13, p = 0.005). Conclusion Approximately one-third of patients received inappropriate antibiotic therapy, representing a substantial antimicrobial stewardship concern despite the observed strengths in culture-guided therapy and infection-focused management.