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Open Forum Infect Dis. 2017 Dec 19;5(2):ofx270. doi: 10.1093/ofid/ofx270. eCollection 2018 Feb.

Potential Adverse Effects of Broad-Spectrum Antimicrobial Exposure in the Intensive Care Unit.

Author information

1
Computer Science and Engineering, University of Michigan, Ann Arbor, Michigan.
2
Department of Health Care Quality and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
3
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
4
Harvard Medical School, Boston, Massachusetts.
5
Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
6
Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts.

Abstract

Background:

The potential adverse effects of empiric broad-spectrum antimicrobial use among patients with suspected but subsequently excluded infection have not been fully characterized. We sought novel methods to quantify the risk of adverse effects of broad-spectrum antimicrobial exposure among patients admitted to an intensive care unit (ICU).

Methods:

Among all adult patients admitted to ICUs at a single institution, we selected patients with negative blood cultures who also received ≥1 broad-spectrum antimicrobials. Broad-spectrum antimicrobials were categorized in ≥1 of 5 categories based on their spectrum of activity against potential pathogens. We performed, in serial, 5 cohort studies to measure the effect of each broad-spectrum category on patient outcomes. Exposed patients were defined as those receiving a specific category of broad-spectrum antimicrobial; nonexposed were all other patients in the cohort. The primary outcome was 30-day mortality. Secondary outcomes included length of hospital and ICU stay and nosocomial acquisition of antimicrobial-resistant bacteria (ARB) or Clostridium difficile within 30 days of admission.

Results:

Among the study cohort of 1918 patients, 316 (16.5%) died within 30 days, 821 (42.8%) had either a length of hospital stay >7 days or an ICU length of stay >3 days, and 106 (5.5%) acquired either a nosocomial ARB or C. difficile. The short-term use of broad-spectrum antimicrobials in any of the defined broad-spectrum categories was not significantly associated with either primary or secondary outcomes.

Conclusions:

The prompt and brief empiric use of defined categories of broad-spectrum antimicrobials could not be associated with additional patient harm.

KEYWORDS:

antibiotic stewardship; antimicrobials; broad-spectrum; intensive care unit; nosocomial

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