Rationale and experience in treating suspected hospital-based mixed infections

Ochsner Foundation Hospital of the Ochsner Medical Institutions (OMI), a 532-bed tertiary care facility in New Orleans, uses a formulary review process common to many institutions. Considered in the selection of antimicrobial therapy are efficacy, safety, and cost. At OMI, ticarcillin-clavulanate plus gentamicin are the standard broad-spectrum antimicrobial agents for initial treatment of suspected mixed infections. The pharmacy department provides an aminoglycoside-monitoring program and convenient dosing guidelines. The regimen has resulted in good therapeutic outcomes and few adverse effects. Bacterial resistance has not been detected. Future plans include a large-scale concurrent review of patient outcomes, resistance patterns, and rates of fungal overgrowth associated with these agents.