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Am J Surg. 2016 Mar;211(3):593-8. doi: 10.1016/j.amjsurg.2015.10.025. Epub 2015 Dec 23.

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

Author information

1
Department of Pharmacy Services, Detroit Receiving Hospital, Wayne State University, Detroit, MI, USA.
2
Michael and Marian Ilitch Department of Surgery, Detroit Receiving Hospital, 4201 St. Antoine Blvd, Suite 4S-13, Wayne State University, Detroit, MI 48201, USA. Electronic address: hdolman@med.wayne.edu.
3
Michael and Marian Ilitch Department of Surgery, Harper University Hospital, Wayne State University, Detroit, MI, USA.
4
Michael and Marian Ilitch Department of Surgery, Detroit Receiving Hospital, 4201 St. Antoine Blvd, Suite 4S-13, Wayne State University, Detroit, MI 48201, USA.

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.

KEYWORDS:

Antibiotics; Appropriate; Bacteremia; Critically ill; Surgery

PMID:
26778270
DOI:
10.1016/j.amjsurg.2015.10.025
[Indexed for MEDLINE]

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