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Impact of a rotating empiric antibiotic schedule on infectious mortality in an intensive care unit
D P Raymond1, S J Pelletier, T D Crabtree
1Department of Surgery, University of Virginia, Charlottesville, VA, USA.
Objective:
The development of antibiotic-resistant bacteria is associated with significant morbidity and mortality in critically ill patients. We postulated that quarterly rotation of empirical antibiotics could decrease infectious complications from resistant organisms in an intensive care unit (ICU).
Design:
Prospective cohort study.
Setting:
An ICU at a university medical center.
Subjects:
All patients admitted to the general, transplant, or trauma surgery services who developed pneumonia, peritonitis, or sepsis of unknown origin.
Interventions:
A 2-yr study consisting of 1 yr of nonprotocol-driven antibiotic use and 1 yr of rotating empirical antibiotic assignment.
Measurements And Main Results:
Over 100 variables were recorded for each infectious episode, including patient characteristics (e.g., Acute Physiology and Chronic Health Evaluation [APACHE] II score, age, comorbidities), infection characteristics (e.g., site, organism), treatment characteristics (e.g., antibiotic, treatment duration) and outcome measures (e.g., mortality, length of stay, antibiotic cost). Of 1456 consecutive admissions to the ICU, 540 episodes of infection were treated. No differences were noted in age, APACHE II score, race, overall antibiotic utilization or duration of therapy between the 2 yrs of study. Outcome analysis revealed significant reductions in the incidence of antibiotic-resistant Gram-positive coccal infections (7.8 infections/100 admissions vs. 14.6 infections/100 admissions, p <.0001), antibiotic-resistant Gram-negative bacillary infections (2.5 infections/100 admissions vs. 7.7 infections/100 admissions, p <.0001), and mortality associated with infection (2.9 deaths/100 admissions vs. 9.6 deaths/100 admissions, p <.0001) during rotation. Logistic regression identified age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.06), APACHE II score (OR, 1.06; 95% CI, 1.01-1.13), solid organ transplantation (OR, 9.50; 95% CI, 2.01-52.21), and malignancy (OR, 10.16; 95% CI, 4.11-26.96) as independent predictors of mortality. Antibiotic rotation was an independent predictor of survival (OR 6.27, 95% CI 2.78-14.16).
Conclusion:
Rotation of empirical antibiotic therapy seems to be a promising method to reduce infectious mortality in an ICU.
Insights
Quarterly rotation of empirical antibiotics in the ICU significantly reduced resistant infections and mortality. This strategy offers a promising approach to improve patient survival and combat antimicrobial resistance in critical care settings.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Antimicrobial Stewardship
Background:
- Antibiotic-resistant bacteria pose a significant threat, causing high morbidity and mortality in intensive care units (ICUs).
- Developing strategies to combat resistant organisms is crucial for improving outcomes in critically ill patients.
Purpose of the Study:
- To investigate the impact of quarterly rotation of empirical antibiotics on infectious complications caused by resistant organisms in an ICU setting.
- To determine if this antibiotic rotation strategy can reduce mortality in critically ill patients.
Main Methods:
- A prospective cohort study was conducted over two years in a university medical center ICU.
- The study compared one year of non-protocol-driven antibiotic use with one year of rotating empirical antibiotic assignments.
- Patients admitted to general, transplant, or trauma surgery services who developed pneumonia, peritonitis, or sepsis of unknown origin were included.
Main Results:
- Antibiotic rotation led to significant reductions in antibiotic-resistant Gram-positive coccal infections (7.8 vs. 14.6 per 100 admissions) and Gram-negative bacillary infections (2.5 vs. 7.7 per 100 admissions).
- Mortality associated with infection decreased significantly (2.9 vs. 9.6 deaths per 100 admissions) during the rotation period.
- Antibiotic rotation was identified as an independent predictor of survival (OR 6.27).
Conclusions:
- Rotation of empirical antibiotic therapy is a promising strategy for reducing infectious mortality in the ICU.
- This approach may help mitigate the impact of antibiotic resistance in critically ill populations.
- Further research into optimized antibiotic rotation protocols is warranted.