Impact of inappropriate initial antibiotics in critically ill surgical patients with bacteremia

• Published in: The American journal of surgery Vol. 211; no. 3; pp. 593 - 598
• Main Authors: Abraham, Katri, Pharm.D, Dolman, Heather S., M.D, Zimmerman, Lisa Hall, Pharm.D, Faris, Janie, Pharm.D, Edelman, David A., M.D, Baylor, Alfred, M.D, Wilson, Robert F., M.D, Tyburski, James G., M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2016; Elsevier Limited
• Subjects: Acinetobacter; Age; Anti-Bacterial Agents - therapeutic use; Antibiotics; APACHE; Appropriate; Bacteremia; Bacteremia - drug therapy; Bacteremia - microbiology; Bacteremia - mortality; Catheters; Chronic obstructive pulmonary disease; Critical Illness; Critically ill; Disease control; Drug dosages; Enterococcus faecium; Family medical history; Female; Hospital Mortality; Hospitals; Humans; Inappropriate Prescribing; Intensive care; Intensive Care Units; Laboratories; Male; Middle Aged; Mortality; Organisms; Retrospective Studies; Staphylococcus infections; Surgery; Surgical Procedures, Operative; Ventilation; Appropriate; Antibiotics; Critically ill; Surgery; Bacteremia
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2015.10.025

Abstract Background Bloodstream infections in critically ill patients are associated with mortality as high as 60% and a prolonged hospital stay. We evaluated the impact of inappropriate antibiotic therapy (IAAT) in a critically ill surgical cohort with bacteremia. Methods This retrospective study evaluated adults with intensive care unit admission greater than 72 hours and bacteremia. Two groups were evaluated: appropriate antibiotic therapy (AAT) vs IAAT. Results In 72 episodes of bacteremia, 57 (79%) AAT and 15 (21%) IAAT, mean age was 54 ± 17 years and APACHE II of 17 ± 8. Time to appropriate antibiotics was longer for IAAT (3 ± 5 IAAT vs 1 ± 1 AAT days, P = .003). IAAT was seen primarily with Acinetobacter spp (33% IAAT vs 9% AAT, P = .01) and Enterococcus faecium (26% IAAT vs 7% AAT, P = .03). If 2 or more bacteremic episodes occurred, Acinetobacter spp. was more likely, 32% vs 2%, P = .001. Conclusions AAT selection is imperative in critically patients with bacteremia to reduce the significant impact of inappropriate selection. Repeated episodes of bacteremia should receive special attention.