NL
In the intensive care unit (ICU), antibiotics are often prescribed longer than guidelines recommend, which may contribute to antibiotic resistance. In our study, published in BMJ Quality and Safety, we examined how decisions about the duration of antibiotic therapy are made during multidisciplinary consultations (MDOs) in the ICU and what factors influence this.
We conducted 20 semi-structured interviews with intensivists, clinical microbiologists and ICU physicians in training in four Dutch ICUs. The analysis revealed that decision-making around antibiotic duration is a complex process that extends over four phases: (1) introduction of the topic “antibiotic duration” in the MDO, (2) discussion of the duration, (3) recording a decision and (4) implementation the decision. Barriers such as nonstandard discussion of antibiotic duration, the absence of crucial team members during MDOs and failure to properly document decisions complicate optimal decision-making. It was also found that antibiotics sometimes go on unintentionally, because stopping points are not properly followed.
Daily MDOs are considered crucial for thoughtful antibiotic treatment. Our findings underscore the importance of well-structured and interdisciplinary decision making. Strengthening communication among healthcare professionals and improving the structure of MDOs can help optimize antibiotic use in the ICU and avoid unnecessarily long treatments. Prof. dr. Marlies Hulscher, dr. Robin Janssen, dr. Anke Oerlemans and Nynke Bos MSc van IQ Health are co-authors of this article.