[Antibacterial chemotherapy in resuscitation. Our clinical experience]

Experience with antibiotic management in a resuscitation centre between 1974 and 1978 is described. An account is given of the incidence of bacteria in excreate, urine, blood, etc. cultures, and of the sensitivity of germs most commonly encountered in such centres to single antibiotics. It is shown that Gram-negative bacteria, particularly Pseudomonas aeruginosa, predominate, and the way in which their sensitivity to antibiotics varies in the course of time is examined. Preparation of an "overall antibiogram" based on assessment of the data made it clear that aminoglycosides and cephalosporins are the drugs of choice for Gram-negative forms, and cephalosporins for Gram-positive bacteria. A critical survey of the results leads to the suggestion that four changes should be made in the approach to antibiotic therapy: 1) elimination of the practice of "preventive" therapy in the form of "initial cover"; 2) withdrawals on admission for bacteriological determinations; 3) abstention or administration of a low-toxicity antibiotic (one of the penicillins) in the case of "minor" infection; 4) employment of potent bactericides of the aminoglycoside group or the polymixines only in cases of superinfection with evidence of septicaemia supported by an antibiogram. It is felt that the essential premiss to sound antibiotic management is the removal of other routes where by infection can enter. Drastic supplementary measures must be taken with regard to the architecture of the premises and the sterilisation of material. Staff training is also essential to prevent the spread of infection from hyperseptic patients.