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Appropriateness of empiric antimicrobial therapy with imipenem/colistin in severe septic patients: observational cohort study.

Abstract：

BACKGROUND:Empiric antimicrobial therapy (EAMT) using imipenem/colistin is commonly prescribed as a first line therapy in critically ill patients with severe sepsis. We aimed to assess the appropriateness of prescribing imipenem/colistin as EAMT in ICU patients. METHODS:A 3-year observational prospective study included ICU patients that required imipenem/colistin as EAMT. The EAMT was assessed according to microbiological and clinical outcomes. The outcomes were: delay in apyrexia, delay in the decrease of the biological inflammatory parameters (BIP), the requirement for vasoactive agents, bacteriological eradication, length of stay, ventilator days and 30-day mortality. RESULTS:79 administrations of EAMT in 70 patients were studied. EAMT was appropriate in 52% of the studied cases. An ICU stay > 6 days was related to inappropriateness, and chronic respiratory failure was associated with appropriateness. In the appropriate EAMT group, we showed: earlier apyrexia, shorter delay in the decrease of the BIP and a reduced significant vasopressors requirement. Furthermore, EAMT improved survival with a median gain of 4 days. Inappropriate EAMT increased the mortality risk by six. The acquisition of NI in ICU was also an independent factor of mortality. CONCLUSIONS:EAMT using imipenem-colistin was appropriate in half of the cases and inappropriateness was associated with an increased ICU mortality risk.

journal_name

Ann Clin Microbiol Antimicrob

journal_title

Annals of clinical microbiology and antimicrobials

authors

Trifi A,Abdellatif S,Abdennebi C,Daly F,Nasri R,Touil Y,Ben Lakhal S

doi

10.1186/s12941-018-0292-7

subject

Has Abstract

pub_date

2018-11-16 00:00:00

pages

39

issue

1

issn

1476-0711

pii

10.1186/s12941-018-0292-7

journal_volume

17

pub_type

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