{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:56:34Z","timestamp":1790751394743,"version":"4.1.0"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Health Serv."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>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\u2005h 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\u2009=\u20093.34,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) and sepsis (AOR\u2009=\u20092.12,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002) as factors independently associated with higher odds of appropriate antibiotic use. Conversely, the presence of a central venous catheter (AOR\u2009=\u20090.30,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003) was associated with lower odds of appropriate antibiotic use. Appropriate antibiotic therapy was associated with higher odds of organ dysfunction (AOR\u2009=\u20091.69,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.032), nosocomial infection (AOR\u2009=\u20092.28,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005), and persistent infection despite therapy (AOR\u2009=\u20092.13,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frhs.2026.1900610","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:05:17Z","timestamp":1790748317000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Antibiotic prescribing appropriateness among critically ill patients at a single tertiary care center in the United Arab Emirates: a retrospective cohort study"],"prefix":"10.3389","volume":"6","author":[{"given":"Inas","family":"Kassis","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University","place":["Ajman, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mosab","family":"Al Balas","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Department, Sheikh Tahnoon Bin Mohammad Medical City","place":["Abu Dhabi, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheilla Hilal Hamed","family":"Rashid","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Department, Sheikh Tahnoon Bin Mohammad Medical City","place":["Abu Dhabi, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shabaz Mohiuddin","family":"Gulam","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University","place":["Ajman, United Arab Emirates"]},{"name":"Clinical Pharmacy Department, Thumbay University Hospital","place":["Ajman, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jisha","family":"Myalil Lucca","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University","place":["Ajman, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly Caye","family":"McKeirnan","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University","place":["Pullman, WA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vineetha","family":"Menon","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University","place":["Ajman, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"B1","year":""},{"key":"B2","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1016\/S0140-6736(24)01867-1","article-title":"Global burden of bacterial antimicrobial resistance 1990\u20132021: a systematic analysis with forecasts to 2050","volume":"404","author":"Naghavi","year":"2024","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","author":"Murray","year":"2022","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","first-page":"100561","DOI":"10.1016\/j.lana.2023.100561","article-title":"The burden of antimicrobial resistance in the Americas in 2019: a cross-country systematic analysis","volume":"25","author":"Aguilar","year":"2023","journal-title":"Lancet Reg Health Am"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e897","DOI":"10.1016\/S2468-2667(22)00225-0","article-title":"The burden of bacterial antimicrobial resistance in the WHO European region in 2019: a cross-country systematic analysis","volume":"7","author":"Mestrovic","year":"2022","journal-title":"Lancet Public Health"},{"key":"B6","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1186\/s44158-023-00095-6","article-title":"Rationale and clinical application of antimicrobial stewardship principles in the intensive care unit: a multidisciplinary statement","volume":"3","author":"Cortegiani","year":"2023","journal-title":"J Anesth Analg Crit Care"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e0000424","DOI":"10.1371\/journal.pdig.0000424","article-title":"Unveiling the dynamics of antimicrobial utilization and resistance in a large hospital network over five years: insights from health record data analysis","volume":"2","author":"Moradigaravand","year":"2023","journal-title":"PLoS Digit Health"},{"key":"B8","doi-asserted-by":"publisher","first-page":"7209","DOI":"10.2147\/IDR.S378645","article-title":"Impact of irrational use of antibiotics among patients in the intensive care unit on clinical outcomes in Sudan","volume":"16","author":"Abdelkarim","year":"2023","journal-title":"Infect Drug Resist"},{"key":"B9","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1186\/s12879-020-05005-7","article-title":"Inapropriate use of antibiotics effective against gram positive microorganisms despite restrictive antibiotic policies in ICUs: a prospective observational study","volume":"20","author":"\u00d6zger","year":"2020","journal-title":"BMC Infect Dis"},{"key":"B10","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.jhin.2004.07.026","article-title":"Evaluation of antibiotic use in intensive care units of a tertiary care hospital in Turkey","volume":"59","author":"Erbay","year":"2005","journal-title":"J Hosp Infect"},{"key":"B11","doi-asserted-by":"publisher","first-page":"R202","DOI":"10.1186\/cc12896","article-title":"Characteristics and outcomes of culture-negative versus culture-positive severe sepsis","volume":"17","author":"Phua","year":"2013","journal-title":"Crit Care"},{"key":"B12","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/s13613-023-01134-9","article-title":"Antibiotic stewardship in the ICU: time to shift into overdrive","volume":"13","author":"Mokrani","year":"2023","journal-title":"Ann Intensive Care"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1244357","DOI":"10.3389\/fpubh.2023.1244357","article-title":"Antimicrobial resistance in Streptococcus pneumoniae: a retrospective analysis of emerging trends in the United Arab Emirates from 2010 to 2021","volume":"11","author":"Senok","year":"2023","journal-title":"Front Public Health"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1244351","DOI":"10.3389\/fpubh.2023.1244351","article-title":"Methicillin resistant Staphylococcus aureus in the United Arab Emirates: a 12-year retrospective analysis of evolving trends","volume":"11","author":"Thomsen","year":"2023","journal-title":"Front Public Health"},{"key":"B15","first-page":"1","volume-title":"Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report 2022","author":"Thomsen","year":"2022"},{"key":"B16","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s12875-023-02223-1","article-title":"Factors contributing to the variation in antibiotic prescribing among primary health care physicians: a systematic review","volume":"25","author":"Kasse","year":"2024","journal-title":"BMC Prim Care"},{"key":"B17","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1136\/bmjqs-2020-012479","article-title":"Understanding decisions about antibiotic prescribing in ICU: an application of the necessity concerns framework","volume":"31","author":"Pandolfo","year":"2022","journal-title":"BMJ Qual Saf"},{"key":"B18","doi-asserted-by":"publisher","first-page":"493","DOI":"10.2147\/IDR.S187836","article-title":"Rational use of antibiotics in an intensive care unit: a retrospective study of the impact on clinical outcomes and mortality rate","volume":"12","author":"Ali","year":"2019","journal-title":"Infect Drug Resist"},{"key":"B19","doi-asserted-by":"publisher","first-page":"188","DOI":"10.4236\/health.2014.62028","article-title":"Evaluation of rational use of antimicrobial agents in a Brazilian intensive care unit","volume":"6","author":"Cartaxo Salgado","year":"2014","journal-title":"Health"},{"key":"B20","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1080\/23120053.2015.1103956","article-title":"An evaluation of antibiotic prescribing patterns in adult intensive care units in a private hospital in KwaZulu-Natal","volume":"30","author":"Chunnilall","year":"2015","journal-title":"S Afr J Infect Dis"},{"key":"B21","year":""},{"key":"B22","year":""},{"key":"B23","year":""},{"key":"B24","year":""},{"key":"B25","year":""},{"key":"B26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18549\/PharmPract.2024.4.3071","article-title":"Antimicrobial stewardship leads from inpatient point prevalence surveillance of a tertiary-level care hospital","volume":"22","author":"Gulam","year":"2024","journal-title":"Pharm Pract"},{"key":"B27","doi-asserted-by":"publisher","first-page":"51","DOI":"10.22270\/jddt.v14i6.6553","article-title":"The impact of the antimicrobial stewardship program on antibiotic use, resistance patterns, and cost in Madinat Zayed Hospital","volume":"14","author":"ALakkad","year":"2024","journal-title":"J Drug Delivery Ther"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1038\/s41598-020-80219-y","article-title":"Assessment of implementation of antibiotic stewardship program in surgical prophylaxis at a secondary care hospital in Ras Al Khaimah, United Arab Emirates","volume":"11","author":"Alshehhi","year":"2021","journal-title":"Sci Rep"},{"key":"B29","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1093\/jac\/46.3.501","article-title":"Appropriate use of restricted antimicrobial agents in hospitals: the importance of empirical therapy and assisted re-evaluation","volume":"46","author":"Thuong","year":"2000","journal-title":"J Antimicrob Chemother"},{"key":"B30","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1097\/EJA.0000000000001140","article-title":"Nonadherence to antibiotic guidelines in patients admitted to ICU with sepsis is associated with increased mortality: a registry-based, retrospective cohort study","volume":"37","author":"Lindberg","year":"2020","journal-title":"Eur J Anaesthesiol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"4555","DOI":"10.2147\/IDR.S402172","article-title":"Appropriateness of empirical antibiotic therapy in hospitalized patients with bacterial infection: a retrospective cohort study","volume":"16","author":"Luo","year":"2023","journal-title":"Infect Drug Resist"},{"key":"B32","doi-asserted-by":"publisher","first-page":"11","DOI":"10.3390\/ecm3010011","article-title":"Conducting retrospective studies, audits and chart reviews: a practical guide for clinicians","volume":"3","author":"Tran","year":"2026","journal-title":"Emerg Care Med"},{"key":"B33","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/s12874-018-0657-9","article-title":"Methods of sample size calculation in descriptive retrospective burden of illness studies","volume":"19","author":"Johnston","year":"2019","journal-title":"BMC Med Res Methodol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3352\/jeehp.2013.10.12","article-title":"The retrospective chart review: important methodological considerations","volume":"10","author":"Matt","year":"2013","journal-title":"J Educ Eval Health Prof"},{"key":"B35","year":""},{"key":"B36","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1164\/rccm.201708-1717LE","article-title":"Evaluation of the 2016 Infectious Diseases Society of America\/American Thoracic Society guideline criteria for risk of multidrug-resistant pathogens in patients with hospital-acquired and ventilator-associated pneumonia in the ICU","volume":"197","author":"Ekren","year":"2018","journal-title":"Am J Respir Crit Care Med"},{"key":"B37","doi-asserted-by":"publisher","first-page":"269","DOI":"10.4314\/sjms.v4i3.48321","article-title":"Assessment of antibiotics prescription in hospitalized patients at Elobeid Hospital, Sudan","volume":"4","author":"Elfaki","year":"2009","journal-title":"Sudan J Med Sci"},{"key":"B38","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1016\/j.jointm.2022.10.001","article-title":"Antimicrobial stewardship in the intensive care unit","volume":"3","author":"Ture","year":"2023","journal-title":"J Intensive Med"},{"key":"B39","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1186\/s13054-014-0480-6","article-title":"Antibiotic stewardship in the intensive care unit","volume":"18","author":"Luyt","year":"2014","journal-title":"Crit Care"},{"key":"B40","doi-asserted-by":"publisher","first-page":"100431","DOI":"10.1016\/j.rcsop.2024.100431","article-title":"Clinical pharmacist interventions in an intensive care unit reduces ICU mortality at a tertiary hospital in Dubai, United Arab Emirates","volume":"14","author":"Ali Hussain Alsayed","year":"2024","journal-title":"Explor Res Clin Soc Pharm"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1093\/jac\/dky572","article-title":"Effectiveness of interventions involving pharmacists on antibiotic prescribing by general practitioners: a systematic review and meta-analysis","volume":"74","author":"Saha","year":"2019","journal-title":"J Antimicrob Chemother"},{"key":"B42","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1016\/j.aucc.2022.12.011","article-title":"Benefits of pharmacist intervention in the critical care patients with infectious diseases: a propensity score matching retrospective cohort study","volume":"36","author":"Gu","year":"2023","journal-title":"Aust Crit Care"},{"key":"B43","doi-asserted-by":"publisher","first-page":"195","DOI":"10.2146\/ajhp120568","article-title":"Clinical practice guidelines for antimicrobial prophylaxis in surgery","volume":"70","author":"Bratzler","year":"2013","journal-title":"Am J Health Syst Pharm"},{"key":"B44","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1542\/hpeds.2021-006204","article-title":"Prolonged perioperative antibiotics: a hidden problem","volume":"12","author":"Salas","year":"2022","journal-title":"Hosp Pediatr"},{"key":"B45","doi-asserted-by":"publisher","first-page":"688","DOI":"10.15537\/smj.2025.46.6.20241061","article-title":"The impact of antibiotic prophylaxis appropriateness, duration and associated cost on the rate of surgical site infection at a tertiary hospital in Riyadh, Saudi Arabia: a retrospective study","volume":"46","author":"Bin Akresh","year":"2025","journal-title":"Saudi Med J"},{"key":"B46","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1001\/jamaoto.2019.0879","article-title":"Evaluation of prolonged vs short courses of antibiotic prophylaxis following ear, nose, throat, and oral and maxillofacial surgery: a systematic review and meta-analysis","volume":"145","author":"Oppelaar","year":"2019","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"B47","doi-asserted-by":"publisher","first-page":"1232","DOI":"10.1093\/cid\/cir063","article-title":"Strategies for reduction in duration of antibiotic use in hospitalized patients","volume":"52","author":"Hayashi","year":"2011","journal-title":"Clin Infect Dis"},{"key":"B48","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1590\/S1679-45082015RW3145","article-title":"Strategies for appropriate antibiotic use in intensive care unit","volume":"13","author":"Silva","year":"2015","journal-title":"Einstein"},{"key":"B49","doi-asserted-by":"publisher","first-page":"1310","DOI":"10.3390\/pathogens10101310","article-title":"Bacterial antibiotic resistance: the most critical pathogens","volume":"10","author":"Mancuso","year":"2021","journal-title":"Pathogens"},{"key":"B50","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1186\/s12879-015-1123-5","article-title":"Appropriate initial antibiotic therapy in hospitalized patients with gram-negative infections: systematic review and meta-analysis","volume":"15","author":"Raman","year":"2015","journal-title":"BMC Infect Dis"},{"key":"B51","doi-asserted-by":"publisher","first-page":"4851","DOI":"10.1128\/AAC.00627-10","article-title":"Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis","volume":"54","author":"Paul","year":"2010","journal-title":"Antimicrob Agents Chemother"},{"key":"B52","doi-asserted-by":"publisher","first-page":"e367","DOI":"10.18295\/squmj.2018.18.03.017","article-title":"Evaluation of antibiotic use among sepsis patients in an intensive care unit: a cross-sectional study at a referral hospital in Indonesia","volume":"18","author":"Dewi","year":"2018","journal-title":"Sultan Qaboos Univ Med J"},{"key":"B53","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1093\/cid\/ciaf118","article-title":"Frequency of antibiotic overtreatment and associated harms in patients presenting with suspected sepsis to the emergency department: a retrospective cohort study","volume":"80","author":"Shappell","year":"2025","journal-title":"Clin Infect Dis"},{"key":"B54","doi-asserted-by":"publisher","first-page":"284","DOI":"10.3389\/fpubh.2016.00284","article-title":"Outcomes and predictive factors associated with adequacy of antimicrobial therapy in patients with central line-associated bloodstream infection","volume":"4","author":"Yokota","year":"2016","journal-title":"Front Public Health"}],"container-title":["Frontiers in Health Services"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1900610\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:05:18Z","timestamp":1790748318000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1900610\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":54,"alternative-id":["10.3389\/frhs.2026.1900610"],"URL":"https:\/\/doi.org\/10.3389\/frhs.2026.1900610","relation":{},"ISSN":["2813-0146"],"issn-type":[{"value":"2813-0146","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"article-number":"1900610"}}