Antibiotic Susceptibility in the Surgical Intensive Care Unit Compared With the Hospital-Wide Antibiogram

• Published in: Archives of surgery (Chicago. 1960) Vol. 133; no. 10; pp. 1041 - 1045
• Main Authors: Kaufman, David, Haas, Curtis E, Edinger, Rita, Hollick, Gary
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 01.10.1998
• Subjects: Biological and medical sciences; Cohort Studies; Hospitals; Humans; Intensive Care Units; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Microbial Sensitivity Tests; Miscellaneous. Technology; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Retrospective Studies; Human; Antibiotic; Sensitivity; Drug susceptibility test; Surgery; Cohort study; Exploration; Hospital; Bacteriology; Comparative study; Retrospective; Intensive care unit
• ISSN: 0004-0010; 2168-6254; 1538-3644; 2168-6262
• DOI: 10.1001/archsurg.133.10.1041

OBJECTIVE To compare the antibiotic susceptibility of bacterial isolates from patients in the sugical intensive care unit (SICU) with hospital-wide bacterial susceptibility. DESIGN Retrospective cohort analytic study. SETTING Eight-bed SICU in a university-affiliated teaching hospital. PATIENTS All hospitalized patients with culture results positive for microorganisms. INTERVENTIONS None. MAIN OUTCOME MEASURES Antibiotic susceptibility data were collected retrospectively for all bacterial isolates from SICU patients during July 1, 1994, to June 30, 1995. All duplicate and surveillance cultures were eliminated from the data set. Susceptibility testing was conducted using our standard laboratory methods. Results were compared with the hospital-wide antibiogram (HWA) for the same time period. Comparisons were made using the χ2 test with Yates correction or the Fisher exact test, as appropriate. Staphylococcus aureus (HWA, n=494; SICU, n=71) was significantly less susceptible to oxacillin (51% vs 28%; P <.001), ciprofloxacin (50% vs 25%; P <.001), erythromycin (46% vs 23%; P<.001), and clindamycin (51% vs 27%; P<.001) in the SICU. Coagulase-negative staphylococci (HWA, n=339; SICU, n=37) were significantly less susceptible to oxacillin (33% vs 16%; P=.04) and clindamycin (57% vs 34%; P=.02). Pseudomonas aeruginosa (HWA, n=513; SICU, n=96) was less susceptible to imipenem (85% vs 74%, P =.01) and more susceptible to ticarcillin–clavulanic acid (88% vs 100%, P<.001) in the SICU. Escherichia coli (HWA, n=474; SICU, n=36) was more susceptible to most penicillin-derivative antibiotics in the SICU (ampicillin [68% vs 83%, P=.06], ticarcillin [65% vs 86%, P =.01], mezlocillin [76% vs 95%, P=.01], and ticarcillin–clavulanic acid [88% vs 100%, P=.02]). CONCLUSIONS The 2 most commonly isolated bacterial pathogens in the SICU (S aureus and P aeruginosa) had significantly different susceptibility patterns compared with the HWA. Surprisingly, E coli isolated in the SICU tended to be more susceptible to penicillin-derivative antibiotics. These data indicate that empiric antibiotic choices in the SICU may be better guided by unit-specific antibiograms.-->