+ Resolve Article
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter

+ Translate
+ Subscribe to Site Feed
GeoScience Most Shared ContentMost Shared Content

Strategies of initiation and streamlining of antibiotic therapy in 41 French intensive care units

, : Strategies of initiation and streamlining of antibiotic therapy in 41 French intensive care units. Critical Care 15(1): R17-R17

Few studies have addressed the decision-making process of antibiotic therapy (AT) in intensive care unit (ICU) patients. In a prospective observational study, all consecutive patients admitted over a one-month period (2004) to 41 French surgical (n = 22) or medical/medico-surgical ICUs (n = 19) in 29 teaching university and 12 non-teaching hospitals were screened daily for AT until ICU discharge. We assessed the modalities of initiating AT, reasons for changes and factors associated with in ICU mortality including a specific analysis of a new AT administered on suspicion of a new infection. A total of 1,043 patients (61% of the cohort) received antibiotics during their ICU stay. Thirty percent (509) of them received new AT mostly for suspected diagnosis of pneumonia (47%), bacteremia (24%), or intra-abdominal (21%) infections. New AT was prescribed on day shifts (45%) and out-of-hours (55%), mainly by a single senior physician (78%) or by a team decision (17%). This new AT was mainly started at the time of suspicion of infection (71%) and on the results of Gram-stained direct examination (21%). Susceptibility testing was performed in 261 (51%) patients with a new AT. This new AT was judged inappropriate in 58 of these 261 (22%) patients. In ICUs with written protocols for empiric AT (n = 25), new AT prescribed before the availability of culture results (P = 0.003) and out-of-hours (P = 0.04) was more frequently observed than in ICUs without protocols but the appropriateness of AT was not different. In multivariate analysis, the predictive factors of mortality for patients with new AT were absence of protocols for empiric AT (adjusted odds ratio (OR) = 1.64, 95% confidence interval (95%CI): 1.01 to 2.69), age ≥60 (OR = 1.97, 95% CI: 1.19 to 3.26), SAPS II score >38 (OR = 2.78, 95% CI: 1.60 to 4.84), rapidly fatal underlying diseases (OR = 2.91, 95% CI: 1.52 to 5.56), SOFA score ≥6 (OR = 4.48, 95% CI: 2.46 to 8.18). More than 60% of patients received AT during their ICU stay. Half of them received new AT, frequently initiated out-of-hours. In ICUs with written protocols, empiric AT was initiated more rapidly at the time of suspicion of infection and out-of-hours. These results encourage the establishment of local recommendations for empiric AT.


PMID: 21232098

DOI: 10.1186/cc9961

Other references

Alexis, J., 2001: Lack of human epidermal growth factor receptor 2 over-expression in melanoma. Journal of Cutaneous Pathology 28(10): 556, November

White A.J.R.; Chappell Bruce W., 1985: Chemical evidence for different sources of granite magmas. Abstracts with Programs - Geological Society of America 17(7): 749

Mushkacheva G.S.; Turdakova V.A.; Rysina T.N.; Luzanova O.V.; Rogacheva S.A., 1979: Therapeutic effect of dna preparations of different molecular mass on irradiated rats. Wistar rats exposed to doses of 750, 820, 840 and 875 R were studied to determine the therapeutic effect of different molecular masses of DNA from thymus and spleen. Initial preparations of molecular mass 34 .times. 106 daltons were degraded mecha...

Solheim, K., 1963: Closed Thoracic Injuries. Acta Chirurgica Scandinavica 126: 549-557

Gao, L-Wei.; Xie, Z-De.; Liu, Y-Yi.; Wang, Y.; Shen, K-Ling., 2011: Epidemiologic and clinical characteristics of infectious mononucleosis associated with Epstein-Barr virus infection in children in Beijing, China. infectious mononucleosis (IM) is a self-limited disease, but a few cases may have severe complications. This retrospective study was to explore the epidemiologic and clinical characteristics of IM associated with Epstein-Barr virus infection (EBV-...

Mishra, V.; Rajavashisth, T., 2017: Shotha and the Unified Theory of Inflammatory Diseases 2017. Journal of Ayurveda and Integrative Medicine 8(3): 211-212

Merimsky, E.; Papo, J.; Zaltzman, S.; Braf, Z., 1986: High ligation or embolization of varicocele. The presence of a varicocele was confirmed in 121 of 123 patients complaining of scrotal pain or infertility, in whom radionuclide scanning was performed. In the first 29 patients (retrospective study), a high ligation of the internal spermatic ve...

Akino, M.; Segawa, K.; Shimbo, M.; Chiba, M.; Sekiguchi, S., 1998: Autologous cryo-sealant by combined plasma separation and cryo-seal system. Vox Sanguinis 74(SUPPL 1): 1195, June

Sahebjami H.; Gacad G.; Massaro D., 1973: Influence of cortico steroids on recovery from oxygen toxicity. Clinical Research 21(1): 73

Okitsu S.; Ito K., 1989: Conditions for the development of the pinus pumila zone of hokkaido northern japan. The development of the Pinus pumila zone of Hokkaido, northern Japan is discussed on the basis of an examination of the Warmth Index (WI). The Pinus pumila zone is developed on deforested areas in the boreal subalpine belt, and is characterized by...