Effects of a comprehensive antimicrobial stewardship program in a surgical intensive care unit

[Display omitted] •Antibiotics stewardship program (ASP) in the surgical ICU was implemented.•Comprehensive ASP decreased the use of anti-pseudomonal beta-lactams.•Susceptibilities of anti-pseudomonal beta-lactams were improved during ASP period.•Comprehensive ASP was a factor associated with decreased mortality in surgical ICU.•ASP should be implemented to improve antimicrobial use and patient outcome. We evaluated the effects of a comprehensive antimicrobial stewardship program (ASP) in a surgical intensive care unit (SICU). The ASP was implemented from March 2018 to February 2019 at an SICU in a teaching hospital. An infectious disease physician and a pharmacist visited the SICU 3 times per week for prospective audit and feedback. Outcomes were compared between the ASP period and the same months in the preceding year (pre-ASP period). The primary outcome measure was the use of anti-pseudomonal beta-lactams (APBL). Appropriate antimicrobial de-escalation and ICU mortality rates were also compared. A total of 182 and 149 patients were included in the study for the pre-ASP and ASP periods, respectively. Although disease severity was higher in the ASP group (septic shock 39.0% in pre-ASP vs 65.1% in ASP group, P