Impact of inappropriate initial antibiotics in critically ill surgical patients with bacteremia.

Abstract:

BACKGROUND:Bloodstream infections in critically ill patients are associated with mortality as high as 60% and a prolonged hospital stay. We evaluated the impact of inappropriate antibiotic therapy (IAAT) in a critically ill surgical cohort with bacteremia. METHODS:This retrospective study evaluated adults with intensive care unit admission greater than 72 hours and bacteremia. Two groups were evaluated: appropriate antibiotic therapy (AAT) vs IAAT. RESULTS:In 72 episodes of bacteremia, 57 (79%) AAT and 15 (21%) IAAT, mean age was 54 ± 17 years and APACHE II of 17 ± 8. Time to appropriate antibiotics was longer for IAAT (3 ± 5 IAAT vs 1 ± 1 AAT days, P = .003). IAAT was seen primarily with Acinetobacter spp (33% IAAT vs 9% AAT, P = .01) and Enterococcus faecium (26% IAAT vs 7% AAT, P = .03). If 2 or more bacteremic episodes occurred, Acinetobacter spp. was more likely, 32% vs 2%, P = .001. CONCLUSIONS:AAT selection is imperative in critically patients with bacteremia to reduce the significant impact of inappropriate selection. Repeated episodes of bacteremia should receive special attention.

journal_name

Am J Surg

authors

Abraham K,Dolman HS,Zimmerman LH,Faris J,Edelman DA,Baylor A,Wilson RF,Tyburski JG

doi

10.1016/j.amjsurg.2015.10.025

subject

Has Abstract

pub_date

2016-03-01 00:00:00

pages

593-8

issue

3

eissn

0002-9610

issn

1879-1883

pii

S0002-9610(15)30017-9

journal_volume

211

pub_type

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