Appropriateness of Antibiotic Therapy and its Association with Clinical Outcomes among Critically Ill Patients: A Retrospective Study from the United Arab Emirates

Background Inappropriate antibiotic prescribing is a major driver of antimicrobial resistance and preventable harm, with patients in intensive care units being particularly vulnerable due to frequent and complex antibiotic exposure. Despite expanding antimicrobial stewardship efforts, contemporary evidence evaluating prescribing quality and its clinical implications in intensive care settings within the United Arab Emirates remains limited. Methods A retrospective cohort study was conducted in the intensive care unit of a tertiary care hospital. Adult patients admitted between January 2023 and December 2024, with a length of stay exceeding 24 hours but less than 30 days, who 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, assessing indication, empiric choice, agent selection, dose, route and frequency, duration, microbiologic concordance, and therapeutic drug monitoring. Results Among 8,697 antibiotic orders retrieved, 1,859 unique records were identified, of which 500 patient records met the eligibility criteria and were analyzed. Overall, 36% of patients received inappropriate antibiotic therapy. The most common reason for inappropriateness was the absence of a clear indication, particularly related to postoperative prophylaxis (44.4%). At the agent level, cefuroxime (76.5%), cefepime (48.2%), and clindamycin (37.1%) exhibited the highest rates of inappropriate use. Multivariable logistic regression identified positive culture results (AOR 1.25, p  < 0.001) and sepsis (AOR 1.18, p  = 0.0025) as predictors of appropriate antibiotic use, whereas the presence of a central line was inversely associated (AOR 0.79, p  = 0.004). Conclusion The overall rate of inappropriate antibiotic prescribing was relatively low, reflecting strengths in culture-guided therapy and infection-focused management. Nevertheless, persistent gaps were identified in postoperative prophylaxis and surgical prescribing practices. These findings highlight the need for targeted antimicrobial stewardship interventions within surgical specialties to further optimize antibiotic use in critically ill patients.