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[Antibiotic prophylaxis in intensive care patients]
Wiener Klinische Wochenschrift. Supplementum
|January 1, 1976
Summary
Antibiotic prophylaxis in intensive care patients did not reduce overall infection or mortality rates. However, it increased gram-negative tracheal flora and delayed, but did not prevent, sepsis.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Clinical Pharmacology
Background:
- Antibiotic prophylaxis is commonly used in intensive care units (ICUs) to prevent bacterial infections.
- The efficacy and impact of prophylactic antibiotics on infection rates, mortality, and microbial flora in critically ill patients remain areas of investigation.
Purpose of the Study:
- To evaluate the effect of antibiotic prophylaxis on infection rates, mortality, and the development of resistant bacterial flora in intensive care patients.
- To assess the influence of prophylactic antibiotics on specific types of infections, including pleuropulmonary, urinary tract, and peritonitis.
Main Methods:
- A randomized controlled trial involving 132 intensive care patients without initial signs of bacterial infection.
- Patients were divided into two groups: one received prophylactic antibiotics (penicillins or cephalosporins), and the other received no prophylaxis.
- Data collected included infection rates, mortality, types of infections, causative organisms, resistance patterns, and environmental bacterial surveillance.
Main Results:
- Antibiotic prophylaxis did not reduce overall infection rates or mortality.
- A significant increase in gram-negative tracheal flora was observed from the third day of prophylaxis.
- While urinary tract infections were reduced, no significant difference in bacteriuria was noted after five days.
- Septicemia incidence was not affected, but its onset was delayed in the prophylaxis group.
- Infections in the prophylaxis group were often caused by resistant Enterobacteriaceae, Pseudomonas, and Candida species.
Conclusions:
- Prophylactic antibiotics in this ICU population did not improve infection or mortality outcomes.
- The use of prophylactic antibiotics led to an increase in resistant gram-negative bacteria in tracheal flora and altered the spectrum of causative pathogens.
- Fever was identified as a reliable indicator of infection, while leukocyte counts were not significantly different.