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Updated: Oct 7, 2026

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
11:17

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

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.

Critical Care Medicine
|June 8, 2001
PubMed
Abstract

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.

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