TY - JOUR
T1 - Decision-making regarding antibiotic therapy duration
T2 - An observational study of multidisciplinary meetings in the intensive care unit
AU - Janssen, Robin M.E.
AU - Oerlemans, Anke J.M.
AU - van der Hoeven, Johannes G.
AU - Oostdijk, Evelien A.N.
AU - Derde, Lennie P.G.
AU - ten Oever, Jaap
AU - Wertheim, Heiman F.L.
AU - Hulscher, Marlies E.J.L.
AU - Schouten, Jeroen A.
N1 - Funding Information:
This work was supported in part by a research grant from the Investigator Initiated Studies Program of Merck Sharp and Dohme [grant number 58288 ]. The opinions expressed in this paper are those of the authors and do not represent those of Merck Sharp and Dohme Corp. The funders had no role in study design, data collection, data analysis, decision to publish or preparation of the manuscript.
Publisher Copyright:
© 2023 The Authors
PY - 2023/12
Y1 - 2023/12
N2 - Purpose: Antibiotic therapy is commonly prescribed longer than recommended in intensive care patients (ICU). We aimed to provide insight into the decision-making process on antibiotic therapy duration in the ICU. Methods: A qualitative study was conducted, involving direct observations of antibiotic decision-making during multidisciplinary meetings in four Dutch ICUs. The study used an observation guide, audio recordings, and detailed field notes to gather information about the discussions on antibiotic therapy duration. We described the participants' roles in the decision-making process and focused on arguments contributing to decision-making. Results: We observed 121 discussions on antibiotic therapy duration in sixty multidisciplinary meetings. 24.8% of discussions led to a decision to stop antibiotics immediately. In 37.2%, a prospective stop date was determined. Arguments for decisions were most often brought forward by intensivists (35.5%) and clinical microbiologists (22.3%). In 28.9% of discussions, multiple healthcare professionals participated equally in the decision. We identified 13 main argument categories. While intensivists mostly used arguments based on clinical status, clinical microbiologists used diagnostic results in the discussion. Conclusions: Multidisciplinary decision-making regarding the duration of antibiotic therapy is a complex but valuable process, involving different healthcare professionals, using a variety of argument-types to determine the duration of antibiotic therapy. To optimize the decision-making process, structured discussions, involvement of relevant specialties, and clear communication and documentation of the antibiotic plan are recommended.
AB - Purpose: Antibiotic therapy is commonly prescribed longer than recommended in intensive care patients (ICU). We aimed to provide insight into the decision-making process on antibiotic therapy duration in the ICU. Methods: A qualitative study was conducted, involving direct observations of antibiotic decision-making during multidisciplinary meetings in four Dutch ICUs. The study used an observation guide, audio recordings, and detailed field notes to gather information about the discussions on antibiotic therapy duration. We described the participants' roles in the decision-making process and focused on arguments contributing to decision-making. Results: We observed 121 discussions on antibiotic therapy duration in sixty multidisciplinary meetings. 24.8% of discussions led to a decision to stop antibiotics immediately. In 37.2%, a prospective stop date was determined. Arguments for decisions were most often brought forward by intensivists (35.5%) and clinical microbiologists (22.3%). In 28.9% of discussions, multiple healthcare professionals participated equally in the decision. We identified 13 main argument categories. While intensivists mostly used arguments based on clinical status, clinical microbiologists used diagnostic results in the discussion. Conclusions: Multidisciplinary decision-making regarding the duration of antibiotic therapy is a complex but valuable process, involving different healthcare professionals, using a variety of argument-types to determine the duration of antibiotic therapy. To optimize the decision-making process, structured discussions, involvement of relevant specialties, and clear communication and documentation of the antibiotic plan are recommended.
KW - Antibiotic therapy duration
KW - Antimicrobial stewardship
KW - Intensive care unit
KW - Multidisciplinary meetings
KW - Shared decision-making
UR - http://www.scopus.com/inward/record.url?scp=85163472600&partnerID=8YFLogxK
U2 - 10.1016/j.jcrc.2023.154363
DO - 10.1016/j.jcrc.2023.154363
M3 - Article
C2 - 37393864
AN - SCOPUS:85163472600
SN - 0883-9441
VL - 78
JO - Journal of Critical Care
JF - Journal of Critical Care
M1 - 154363
ER -