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Routine microbiological screening in septic patients in a cardiac surgical intensive care unit
D Meininger1, C Byhahn, D Maeser
1Department of Anesthesiology, Intensive Care Medicine and Pain Control, JW Goethe-University Hospital, Frankfurt, Germany.
Introduction:
Patients in a surgical intensive care unit (ICU) have a high incidence of nosocomial infections which often lead to septic shock and death. Since specific antibiotic treatment is often difficult, it is recommended that routine nose/throat swabs be obtained in order to have a better idea of the causative agent when a systemic inflammatory response occurs in a given patient.
Materials And Methods:
In 1435 patients in a cardiac surgical ICU, routine nose/throat swabs were taken thrice a week and tested for microorganisms and systemic inflammation. Blood cultures were also obtained. Antibiotic treatment was given to cover the microbes from the nose/throat swabs. Alternatively, an empirical antibiotic therapy was given to patients whose swabs had tested negative.
Results:
Of the 86 patients with systemic inflammation, 29 had blood cultures positive for microbes. Of these, 18 received a specific antibiotic therapy based on their positive nose/throat cultures prior to the return of the blood cultures from the laboratory. However, only 11 patients tested positive for the same microbes on routine swabs and blood cultures. While positive routine swabs are quite specific to sepsis when there is a systemic inflammatory response, routine swabs are not a suitable screening tool due to their low sensitivity.
Conclusion:
Routine nose/throat swabs led to earlier specific antibiotic treatment in only 22 % of patients with clinical signs of systemic inflammation. In 36 % of cases, the organisms detected in the routine swabs and blood cultures were not identical. Hence, we believe that routine swabs are of limited value in instituting earlier, specific antibiotic therapy in septic patients.
Insights
Routine nose/throat swabs in surgical intensive care units (ICUs) have limited value for early sepsis treatment. While specific, their low sensitivity means many infections are missed, delaying appropriate antibiotic therapy.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Surgical intensive care unit (ICU) patients face high rates of nosocomial infections, often progressing to septic shock and mortality.
- Early identification of causative agents is crucial for effective antibiotic treatment, but can be challenging.
Purpose of the Study:
- To evaluate the utility of routine nose/throat swabs in guiding early, specific antibiotic therapy for patients with systemic inflammation in a cardiac surgical ICU.
Main Methods:
- Routine nose/throat swabs were collected thrice weekly from 1435 cardiac surgical ICU patients.
- Microorganisms and systemic inflammation were assessed; blood cultures were also obtained.
- Antibiotic treatment was guided by swab results or administered empirically if swabs were negative.
Main Results:
- Of 86 patients with systemic inflammation, 29 had positive blood cultures.
- Only 11 patients had matching microbes on both routine swabs and blood cultures.
- Routine swabs showed high specificity for sepsis but low sensitivity, limiting their screening utility.
Conclusions:
- Routine nose/throat swabs facilitated earlier specific antibiotic treatment in only 22% of patients with systemic inflammation.
- In 36% of cases, organisms from swabs and blood cultures did not match.
- The study concludes that routine swabs have limited value for initiating early, specific antibiotic therapy in septic patients.
