Prospective audit of bacteraemia management in a university hospital ICU using a general strategy of short-course monotherapy.
J Antimicrob Chemother
; 54(4): 809-17, 2004 Oct.
Article
en En
| MEDLINE
| ID: mdl-15375106
ABSTRACT
OBJECTIVE:
As optimal antibiotic therapy for bacteraemia remains unknown, different strategies have evolved. Routine practice in the University College London Hospitals intensive care unit (ICU) is to use short-course (5-6 days) monotherapy, unless specifically indicated (e.g. endocarditis, osteomyelitis). We decided to assess this approach for treating community-, hospital-, and ICU-acquired bacteraemia by monitoring clinical response, relapse rate and patient outcome.DESIGN:
Six-month prospective observational study from February to July 2000.SETTING:
Mixed medical-surgical tertiary referral ICU. PATIENTS All 713 patients admitted to the ICU over the study period. MEASUREMENTS ANDRESULTS:
In total, 102 bacteraemic episodes occurred in 84 patients. Eight (57%) of 14 community-acquired bacteraemias, 22 (79%) of 28 hospital-acquired bacteraemias, and 48 (80%) of 60 ICU-acquired bacteraemias (in 49 patients) were treated with short-course monotherapy. Compared with previous reported studies, these patients had a low rate (23.8%) of death directly attributable to the bacteraemia and a satisfactory clinical response in 72%. Of six relapses (all Gram-negative), four had received combination therapy for severe deep-seated infections. ICU-acquired multidrug-resistant Gram-negative bacteraemias (6.5%) and fungaemias (3%) were also uncommon. No patient discharged from ICU subsequently developed a new bacteraemia relapse, or any long-term complication such as osteomyelitis.CONCLUSIONS:
Our general strategy of short-course antibiotic monotherapy for treating bacteraemia in the critically ill appears to provide a satisfactory clinical response, low relapse rate and no long-term complications in a well-defined group of patients. Multicentre studies are warranted to compare short versus long course therapy, and monotherapy versus combination therapy.
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Banco de datos:
MEDLINE
Asunto principal:
Bacteriemia
/
Hospitales Universitarios
/
Antibacterianos
Tipo de estudio:
Observational_studies
/
Risk_factors_studies
Límite:
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
J Antimicrob Chemother
Año:
2004
Tipo del documento:
Article