Principles Governing Antimicrobial Therapy in the Intensive Care Unit

Background: Rapid molecular diagnostic tests can aid in deescalating antimicrobial therapy prior to final culture and susceptibility reports. Objective: The purpose of this study was to determine whether a new workflow that incorporated pharmacist review of these results reduced time to change in antimicrobial therapy. Methods: This retrospective study analyzed pre- and post-implementation of pharmacist review of positive blood cultures analyzed by rapid diagnostics with clinical recommendations paged to providers. Patients 18 years of age or older initiated on empiric antibiotics were included. The primary outcome was the time to change to targeted antimicrobials. Other outcomes evaluated were rates of Clostridioides difficile (C difficile) infection, inpatient mortality, and intensive care unit and hospital lengths of stay. Results: A total of 199 patients were included, with 98 and 101 patients in the pre- and post-implementation groups, respectively. The median time to change to targeted antimicrobials was significantly reduced with pharmacist intervention from 18.35 to 8.43 hours ( P = 0.042). The groups had similar rates of C difficile infection (1% vs 0%, P = 0.492) and mortality (7.1% vs 5%, P = 0.564). The post-group also had significant reductions in antibiotic days of therapy (10.5 vs 9 days, P = 0.014) and intensive care unit length of stay (3.04 vs 1.44 days, P = 0.046). Median hospital length of stay was similar between the pre- and post-groups (8.5 vs 8 days, P = 0.106), respectively. Conclusion: Incorporating pharmacist review of rapid molecular results of blood cultures decreased time to change to targeted antimicrobials and reduced inpatient antibiotic days of therapy.

Download Full-text

Empiric antimicrobial therapy for severe sepsis in the intensive care unit: In early, hit hard, out early

Current Anaesthesia and Critical Care ◽

10.1016/j.cacc.2005.11.009 ◽

2005 ◽

Vol 16 (4) ◽

pp. 221-230 ◽

Cited By ~ 2

Author(s):

C.M. Glynn ◽

B. Azadian

Keyword(s):

Intensive Care Unit ◽

Severe Sepsis ◽

Intensive Care ◽

Antimicrobial Therapy ◽

Empiric Antimicrobial Therapy

Download Full-text

Antimicrobial Use and the Influence of Inadequate Empiric Antimicrobial Therapy on the Outcomes of Nosocomial Bloodstream Infections in a Neonatal Intensive Care Unit

Infection Control and Hospital Epidemiology ◽

10.1086/502469 ◽

2004 ◽

Vol 25 (9) ◽

pp. 735-741 ◽

Cited By ~ 24

Author(s):

Anucha Apisarnthanarak ◽

Galit Holzmann-Pazgal ◽

Aaron Hamvas ◽

Margaret A. Olsen ◽

Victoria J. Fraser

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Antimicrobial Therapy ◽

Neonatal Intensive Care ◽

Severity Of Illness ◽

Bloodstream Infections ◽

Antimicrobial Use ◽

Control Analysis ◽

Empiric Antimicrobial Therapy

AbstractObjective:To evaluate antimicrobial use and the influence of inadequate empiric antimicrobial therapy on the outcomes of nosocomial bloodstream infections (BSIs).Design:Prospective cohort study with nested case-control analysis.Setting:Neonatal intensive care unit (NICU).Methods:All patients weighing 2,000 g or less were enrolled. Data collection included risk factors for nosocomial BSI, admission severity of illness, microbiology, antimicrobial therapy, and outcomes. Inadequate empiric antimicrobial therapy was defined as the use of antibiotics for more than 48 hours after the day that blood cultures were performed that did not cover the microorganisms causing the bacteremia or administration of antibiotics that failed to cover resistant microorganisms.Results:Two hundred twenty-nine patients were enrolled. Forty-five developed nosocomial BSIs. The BSI rates were 11.2, 2.8, and 0 per 1,000 catheter-days for patients weighing 1,000 g or less, between 1,001 and 1,500 g, and between 1,501 and 2,000 g, respectively. After adjustment for severity of illness, the mortality in patients with nosocomial BSI receiving inadequate empiric antimicrobial therapy was higher than in those receiving adequate therapy (adjusted odds ratio [AOR], 5.3; 95% confidence interval [CI95], 1.2-23.2). By multivariate analysis, nosocomial BSI attributed to Candida species (AOR, 6.3; CI95, 1.4-28.0) and invasive procedure prior to onset of BSI (AOR, 6.4; CI95, 1.0-39.0) were associated with administration of inadequate empiric antimicrobial therapy.Conclusions:Administration of inadequate empiric antimicrobial therapy among NICU patients with nosocomial BSI was associated with higher mortality. Additional studies on the role of inadequate empiric antimicrobial therapy and the outcomes of BSIs among NICU patients are needed.

Download Full-text

Pola Pemberian Antimikroba pada Pasien Sepsis di RSUP Prof. Dr. R. D. Kandou Manado Periode Januari - Juni 2019

e-CliniC ◽

10.35790/ecl.v7i2.26784 ◽

2019 ◽

Vol 7 (2) ◽

Author(s):

Reinhard C. Taroreh ◽

Harold F. Tambajong ◽

Diana Ch. Lalenoh

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Mortality Rate ◽

Medical Record ◽

Organ Dysfunction ◽

Antimicrobial Therapy ◽

Analytical Study ◽

Cross Sectional ◽

Cross Sectional Design ◽

Antimicrobial Administration

Abstract: Sepsis is defined as organ dysfunction that threatens life due to disregulated response of vulnerable host to the infection agent. Antimicrobial therapy is one of the main therapies in the management of septic cases. Survival sepsis campaign guidelines in 2016 recommended antimicrobial administration in one hour after being diagnosed as sepsis. This study was aimed to determine the pattern of antimicrobial administration among septic patients in the Intensive Care Unit of RSUP Prof. Dr. R. D. Kandou Manado. This was an observational analytical study with a cross-sectional design. Samples were intensive care unit patients of RSUP Prof. Dr. R. D. Kandou Manado diagnosed as sepsis and its classification obtained from the Medical Record Installation data for the period of January to June 2019. The results showed a total of 35 septic patients consisting of 16 females (45.7%) and 19 males (54.3%). The time of antimicrobial administration ≤1 hour was found in 21 cases (60%). The most frequent antimicrobial administered was ceftriaxone in 13 cases (37.1%). The mortality rate after >48 hours was 13 cases (59%). In conclusion, most antimicrobial administration was in 1 hour after being diagnosed as sepsis and ceftriaxone was the most frequent antimicrobial given. Mortality rate after administration of antimicrobial was still high.Keywords: sepsis, ICU, antimicrobial, mortality rate Abstrak: Sepsis didefinisikan sebagai disfungsi organ yang mengancam nyawa akibat disregulasi respon penjamu terhadap infeksi. Terapi antimikroba merupakan salah satu terapi utama dalam penatalaksanaan kasus sepsis. Pedoman Survival Sepsis Campaign tahun 2016 menyatakan pemberian antimikroba yang direkomendasikan ialah satu jam setelah terdiagnosiss sepsis. Penelitian ini bertujuan untuk mengetahui pola pemberian antimikroba pada pasien sepsis di Intensive Care Unit RSUP Prof. Dr. R. D. Kandou Manado. Jenis penelitian ialah analitik observasional dengan desain potong lintang. Sampel penelitian ialah pasien ICU Prof. Dr. R. D. Kandou Manado dengan diagnosis sepsis dan klasifikasinya, diperoleh dari data Bagian Instalasi Rekam Medik periode Januari-Juni 2019. Hasil penelitian mendapatkan total 35 pasien dengan diagnosis sepsis, terdiri dari 16 orang perempuan (45,7%) dan 19 orang laki-laki (54,3%). Waktu pemberian antimikroba ≤1 jam pada sebanyak 21 kasus (60%). Penggunaan antimikroba yang sering diberikan ialah ceftriaxone pada 13 kasus (37,1%). Angka kematian setelah >48 jam sebanyak 13 kasus (59%). Simpulan penelitian ini ialah sebagian besar pemberian antimikroba 1 jam setelah didiagnosis sepsis dengan ceftriaxone sebagai antimikroba yang paling sering diberikan. Angka kematian pasca pemberian antimikroba masih tinggi.Kata kunci: sepsis, ICU, antimikroba, angka kematian

Download Full-text

Sepsis in a Young Man with Thalassemia Major: A Case Report

Journal of Clinical Cases & Reports ◽

10.46619/joccr.2018.1-1008 ◽

2018 ◽

Vol 1 (1) ◽

pp. 36-38

Author(s):

Atak Burcin ◽

◽

Aktas Gulali ◽

Duman Tuba ◽

Kocak Zahid ◽

...

Keyword(s):

Internal Medicine ◽

Intensive Care Unit ◽

Intensive Care ◽

Abdominal Pain ◽

Case Report ◽

Iron Overload ◽

Antimicrobial Therapy ◽

General Condition ◽

Thalassemia Major ◽

Blood Transfusions

A 23-year-old young man with a transfusion-dependent thalassemia major presented to internal medicine outpatient clinic of our institution. His complaints included fatigue and abdominal pain for 1-2 days. He needed blood transfusions in every two weeks. On admission, he had a fever that not responded to empiric antibiotics. General condition of the patient deteriorated rapidly and he died in intensive care unit of our institution. In conclusion, physicians should aware of serious infectious caused by such microorganisms in patients with iron overload and proper antimicrobial therapy should be initiate at once.

Download Full-text

The effect of prior antimicrobial therapy for community acquired infections on the aetiology of early and late onset ventilator-associated pneumonia in a level I trauma intensive care unit

Southern African Journal of Infectious Diseases ◽

10.4102/sajid.v32i3.45 ◽

2017 ◽

Vol 32 (3) ◽

pp. 91-95

Author(s):

Yogandree Ramsamy ◽

David J.J. Muckart

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Antimicrobial Therapy ◽

Late Onset ◽

Bacterial Flora ◽

First Episode ◽

Ventilator Associated Pneumonia ◽

Bacterial Isolates ◽

Prior Therapy ◽

Hospital Acquired

Background: Ventilator-associated pneumonia (VAP) is the most common hospital acquired infection in patients who require mechanical ventilation. Early VAP is associated with community acquired pathogens whereas late VAP involves hospital flora. Based on this premise, a protocol may be formulated for microbiological surveillance and antimicrobial stewardship within a specific intensive care unit (ICU) to ensure appropriate empiric antimicrobial choice. The bacterial flora in VAP may be affected, however, by antimicrobials prescribed during the ICU stay. Aim: The aim of this study was to determine the effect of prior antimicrobial therapy for community acquired infections on aetiology and the susceptibility of bacterial isolates from the first episode of early or late VAP in a trauma intensive care unit.Methods: Endotracheal aspirates (ETAs) were obtained from patients with suspected early and late VAP. All ETAs were processed and interpreted as per the Clinical and Laboratory Standards Institute (CLSI). Patients were divided into two cohorts: those whose injuries had required antimicrobial therapy for community acquired infections and those who were antimicrobial naïve. The effect of prior antimicrobial therapy on bacterial isolates from the first episode of suspected VAP was compared between the two groups.Results: Of 288 patients admitted to the Trauma ICU between January and December 2014, pneumonia was suspected in 91 (31.6%). Of these, 69 (76%) patients were antimicrobial naïve and 22 (24%) had received prior antimicrobial therapy. Early VAP occurred in 31 (45%) patients in the naïve cohort compared to 3 (12.5%) with prior antimicrobial exposure (p = 0.01). Of the early VAP isolates 25 (81%) in the naïve cohort contained community flora, whereas all isolates in those with prior antimicrobial therapy revealed hospital acquired organisms (p = 0.01). In the antimicrobial naïve cohort with late VAP 27 (71%) patients had community acquired organisms, whereas only 3 (16%) isolates in late VAP in those with prior therapy revealed community acquired flora (p 0.001).Conclusion: Patients who receive prior antimicrobial therapy have a significantly lower incidence of early VAP, but in those who developed either early or late VAP hospital acquired pathogens were more commonly isolated. Knowledge of prior antimicrobial exposure in a patient with early or late VAP will assist in determining the correct empiric antimicrobial choice.

Download Full-text

Clinical Utility of Rapid Pathogen Identification for Detecting the Causative Organisms in Sepsis: A Single-Center Study in Korea

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2018/1698241 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8

Author(s):

Won-Young Kim ◽

Eun Suk Jeong ◽

Insu Kim ◽

Kwangha Lee

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Confidence Interval ◽

Intensive Care Unit Admission ◽

Antimicrobial Therapy ◽

Odds Ratio ◽

Pathogen Identification ◽

Maldi Tof Ms ◽

Maldi Tof ◽

Tof Ms

Purpose. The aim of this pre- and postintervention cohort study was evaluating how effectively rapid pathogen identification with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) detected the causative organisms in sepsis.Methods. All consecutive adult patients who had bacteremia within 72 h of intensive care unit admission and met ≥2 quick Sequential Organ Failure Assessment criteria at intensive care unit admission were analyzed. The patients whose microorganisms were identified via MALDI-TOF MS between March 2014 and February 2016 formed the postintervention group. The patients whose microorganisms were identified by using conventional methods between March 2011 and February 2013 formed the preintervention group.Results. The postintervention group (n=58) had a shorter mean time from blood draw to receiving the antimicrobial susceptibility results than the preintervention group (n=40) (90.2 ± 32.1 vs. 108.7 ± 43.1 h;p=0.02). The postintervention group was also more likely to have received active antimicrobial therapy by the time the susceptibility report became available (77% vs. 47%;p=0.005). Its 28-day mortality was also lower (40% vs. 70%;p=0.003). Univariate analysis showed that identification via MALDI-TOF MS (odds ratio, 0.28; 95% confidence interval, 0.12–0.66;p=0.004) and active therapy (odds ratio, 0.38; 95% confidence interval, 0.16–0.95;p=0.04) were associated with lower 28-day mortality.Conclusion. Rapid microorganism identification via MALDI-TOF MS followed by appropriate antimicrobial therapy may improve the clinical outcomes of patients with sepsis.

Download Full-text