• Robin M E Janssen, OerlemansAnke J MAJMRadboud university medical center, Scientific Center for Quality of Healthcare (IQ healthcare), Nijmegen, the Netherlands., Johannes G van der Hoeven, OostdijkEvelien A NEANRijnstate, Department of Intensive Care Medicine, Arnhem, the Netherlands., DerdeLennie P GLPGUniversity Medical Center Utrecht, Department of Intensive Care Medicine, Utrecht, the Netherlands., Jaap Ten Oever, WertheimHeiman F LHFLRadboud university medical center, Radboud Center for Infectious Diseases (RCI), Nijmegen, the Netherlands; Radboud university medical center, Department of Medical Microbiology, Nijmegen, the Netherlands., HulscherMarlies E J LMEJLRadboud university medical center, Scientific Center for Quality of Healthcare (IQ healthcare), Nijmegen, the Netherlands; Radboud university medical center, Radboud Center for Infectious Diseases (RCI), Nijmegen, the Netherlands., and Jeroen A Schouten.
• Radboud university medical center, Department of Intensive Care Medicine, Nijmegen, the Netherlands; Radboud university medical center, Scientific Center for Quality of Healthcare (IQ healthcare), Nijmegen, the Netherlands; Radboud university medical center, Radboud Center for Infectious Diseases (RCI), Nijmegen, the Netherlands. Electronic address: Robin.Janssen@radboudumc.nl.
• J Crit Care. 2023 Dec 1; 78: 154363154363.

PurposeAntibiotic 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.MethodsA 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.ResultsWe 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.ConclusionsMultidisciplinary 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.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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