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<h3>Background and Importance</h3> The inappropriate and excessive use of broad-spectrum antibiotics represents a critical public health issue, contributing to the emergence and spread of antimicrobial resistance. Intensive care units (ICUs) are particularly affected due to the frequent use of high-potency antibiotics to manage severe infections. According to the WHO AWaRe classification, the WATCH and RESERVE groups require close monitoring because of their potential to select resistant strains. Understanding local antibiotic consumption patterns is essential for implementing effective antimicrobial stewardship strategies and preserving the efficacy of last-resort agents. <h3>Aim and Objectives</h3> This study aimed to evaluate the consumption of antibiotics belonging to the WHO WATCH and RESERVE groups in ICUs. Specific objectives were to describe prescription patterns, identify infection sites and isolated pathogens, and assess the degree of microbiological documentation supporting antibiotic use. <h3>Material and Methods</h3> A retrospective, descriptive, and analytical study was carried out over three months (January–March 2023). All ICU patients who received at least one antibiotic from the WATCH or RESERVE groups were included. Data were collected from medical records and pharmacy dispensing databases. Parameters analysed included demographic data, indications, bacterial isolates, and antibiotic consumption expressed as Defined Daily Doses (DDD) per 1000 patient-days, calculated according to WHO methodology. <h3>Results</h3> A total of 263 prescriptions were analysed. The mean patient age was 56 years; 39% were aged 30–60 and 49% over 60, with a sex ratio (M/F) of 1.5. Antibiotic therapy was prophylactic in 43%, empirical in 40%, and based on microbiological documentation in 17%. The most frequent infection sites were bacteraemia (39%) and respiratory infections (35%). A total of 157 bacterial strains were isolated, mainly <i>Acinetobacter baumannii</i> (18%), <i>Escherichia coli</i> (16%), and coagulase-negative staphylococci (14%). WATCH-group consumption was higher (375 DDD/1000 patient-days) than RESERVE (59.9). Ceftriaxone and teicoplanin were most used (61 each), followed by levofloxacin (59) and ertapenem (53). Tigecycline was the leading RESERVE antibiotic (27.8 DDD/1000 patient-days). <h3>Conclusion and Relevance</h3> WATCH-group antibiotics accounted for most ICU prescriptions, consistent with international trends. Although RESERVE-group use remained appropriately limited, the low microbiological documentation rate highlights the need to reinforce diagnostic support and stewardship programs. Rationalising antibiotic use is essential to reduce resistance emergence and preserve the effectiveness of last-resort molecules. <h3>Conflict of Interest</h3> No conflict of interest