Background: The burden of antimicrobial resistance in healthcare settings is especially prevalent at the intensive care unit (ICU). It is important that physicians and nurses appropriately use antibiotics and adhere to antibiotic use recommendations to conserve currently available antibiotics. Methods: A retrospective analysis of patients’ medical and nursing records was conducted to study the adherence to recommendations that define appropriate antibiotic use. Two sets of quality indicators were studied in the ICU of a large non university teaching hospital in the Netherlands: [1] quality indicators for appropriate antibiotic use at the ICU, and [2] quality indicators on Selective Digestive tract Decontamination (SDD). Results: A total of 150 patients were included. The highest adherence rate was found for the recommendation ‘stop third generation cephalosporin therapy as part of SDD after four days’ (44/46; 95.7%). Attention should be paid to doubling the dose of oral and enteral SDD if so required by protocol, as professionals adhered to this recommendation in only 26.3% of the patients (10/38). Conclusions: The quality indicators applied in this study can be used by hospital antibiotic stewardship teams to determine where to set priorities to improve antibiotic use in ICU patients. More research in other ICUs is needed to gain better insight into the adherence to recommended antibiotic use in daily practice. In a next step, stewardship teams should gain insight into the barriers and facilitators that influence recommended use. Such information is important to develop effective interventions. © 2018, Netherlands Society of Intensive Care. All rights reserved.