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Cited by 161Antibiotics Pharmacokinetics and EfficacySepsis Diagnosis and TreatmentAntibiotic Use and Resistance

Timing of antibiotic therapy in the ICU

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Kollef, Marin H., Shorr, Andrew F., Bassetti, Matteo, Timsit, Jean-Francois, Micek, Scott T., Michelson, Andrew P., Garnacho-Montero, Jose·2021·Critical Care
DOI 10.1186/s13054-021-03787-zPMC PMC8518273
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Abstract

Severe or life threatening infections are common among patients in the intensive care unit (ICU). Most infections in the ICU are bacterial or fungal in origin and require antimicrobial therapy for clinical resolution. Antibiotics are the cornerstone of therapy for infected critically ill patients. However, antibiotics are often not optimally administered resulting in less favorable patient outcomes including greater mortality. The timing of antibiotics in patients with life threatening infections including sepsis and septic shock is now recognized as one of the most important determinants of survival for this population. Individuals who have a delay in the administration of antibiotic therapy for serious infections can have a doubling or more in their mortality. Additionally, the timing of an appropriate antibiotic regimen, one that is active against the offending pathogens based on in vitro susceptibility, also influences survival. Thus not only is early empiric antibiotic administration important but the selection of those agents is crucial as well. The duration of antibiotic infusions, especially for β-lactams, can also influence antibiotic efficacy by increasing antimicrobial drug exposure for the offending pathogen. However, due to mounting antibiotic resistance, aggressive antimicrobial de-escalation based on microbiology results is necessary to counterbalance the pressures of early broad-spectrum antibiotic therapy. In this review, we examine time related variables impacting antibiotic optimization as it relates to the treatment of life threatening infections in the ICU. In addition to highlighting the importance of antibiotic timing in the ICU we hope to provide an approach to antimicrobials that also minimizes the unnecessary use of these agents. Such approaches will increasingly be linked to advances in molecular microbiology testing and artificial intelligence/machine learning. Such advances should help identify patients needing empiric antibiotic therapy at an earlier time point as well as the specific antibiotics required in order to avoid unnecessary administration of broad-spectrum antibiotics.

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  • Approximately 47.3% of ICU patients with BSIs receive inadequate therapy within the first 24 h of symptom onset.

    “However, in some BSIs patients with less typical presentations delayed treatment is common: approximately 47.3% of ICU patients with BSIs receive inadequate therapy within the first 24 h of symptom onset [5–7].”

    From Early prediction of bloodstream infections in ICU patients using machine learning methods based on routine laboratory parameters (2025) · cites this paper as [5]

    The Conclusions (no page given) discuss delayed appropriate therapy in bloodstream infections, and the Abstract says ICU antibiotics are often not optimally administered. Neither passage reports that 47.3% of ICU patients with BSIs receive inadequate therapy within 24 hours of symptom onset, or links delays to less typical presentations. (LLM, conf=0.83)

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Authors
Kollef, M. H., Shorr, A. F., Bassetti, M., Timsit, J.-F., Micek, S. T., Michelson, A. P., & Garnacho-Montero, J.
Affiliations
  • Washington University in St. Louis (US)
  • MedStar Washington Hospital Center (US)
  • Ospedale Policlinico San Martino (IT)
  • University of Health Sciences and Pharmacy (US)
Corresponding author
Kollef, Marin H.
ORCID
Venue
Critical Care
Publisher
Springer Science and Business Media LLC
Published
2021-10-15
Volume
25
Issue
1
Pages
360-360
ISSN
1364-8535 (ISSN-L)
DOI
10.1186/s13054-021-03787-z
PMC
PMC8518273
OpenAlex
W3207639082
Cited by
161
References
9
Citations by year
2026: 30 · 2025: 42 · 2024: 40 · 2023: 33 · 2022: 15 · 2018: 1
FWCI
2.82
Type
journal article
Language
en
Open access
Licence
Locations
  • Critical Care (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Digital Commons@Becker (Washington University School of Medicine) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Pharmacology › Antibiotics Pharmacokinetics and Efficacy
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
Keywords
timing of antibiotic administration, intensive care unit infections, sepsis, septic shock, empirical antibiotic therapy, antibiotic de-escalation, antibiotic resistance, antimicrobial exposure, critically ill patients, mortality
MeSH terms
Anti-Bacterial Agents, Humans, Intensive Care Units, Time Factors

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