Short-course Empiric Antibiotic Therapy for Patients with Pulmonary Infiltrates in the Intensive Care Unit

Empiric antibiotic therapy is routinely initiated for patients with presumed ventilator-associated pneumonia (VAP). Reported mortality rates for inadequate empiric antibiotic therapy (IEAT) for VAP range from 45 to 91 per cent. The purpose of this study was to determine the effect of a unit-specific pathway for the empiric management of VAP on reducing IEAT episodes and improving outcomes in trauma patients. Patients admitted with VAP over 36-months were identified and stratified by gender, age, severity of shock, and injury severity. Outcomes included number of IEAT episodes, ventilator days, intensive care unit days, hospital days, and mortality. Three hundred and ninety-three patients with 668 VAP episodes were identified. There were 144 (22%) IEAT episodes: significantly reduced compared with our previous study (39%) ( P < 0.001). Patients were classified by number of IEAT episodes: 0 (n = 271), 1 (n = 98) and ≥ 2 (n = 24). Mortality was 12 per cent, 13 per cent, and 38 per cent ( P < 0.001), respectively. Multivariable logistic regression identified multiple IEAT episodes as an independent predictor of mortality (odds ratio = 4.7; 95% confidence interval: 1.684–13.162). Multiple IEAT episodes were also associated with prolonged mechanical ventilation and intensive care unit stay ( P < 0.001). Trauma patients with multiple IEAT episodes for VAP have increased morbidity and mortality. Adherence to a unit-specific pathway for the empiric management of VAP reduces multiple IEAT episodes. By limiting IEAT episodes, resource utilization and hospital mortality are significantly decreased.

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Does appropriate empiric antibiotic therapy modify intensive care unit-acquired Enterobacteriaceae bacteraemia mortality and discharge?

Journal of Hospital Infection ◽

10.1016/j.jhin.2017.03.016 ◽

2017 ◽

Vol 96 (1) ◽

pp. 23-28 ◽

Cited By ~ 5

Author(s):

K.B. Pouwels ◽

E. Van Kleef ◽

S. Vansteelandt ◽

R. Batra ◽

J.D. Edgeworth ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Antibiotic Therapy ◽

Empiric Antibiotic Therapy ◽

Empiric Antibiotic

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Colonization Status and Appropriate Antibiotic Therapy for Nosocomial Bacteremia Caused by Antibiotic-Resistant Gram-Negative Bacteria in an Intensive Care Unit

Infection Control and Hospital Epidemiology ◽

10.1086/502575 ◽

2005 ◽

Vol 26 (6) ◽

pp. 575-579 ◽

Cited By ~ 75

Author(s):

Stijn Blot ◽

Pieter Depuydt ◽

Dirk Vogelaers ◽

Johan Decruyenaere ◽

Jan De Waele ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Antibiotic Therapy ◽

Empiric Antibiotic Therapy ◽

Gram Negative Bacteria ◽

Antibiotic Resistant ◽

Gram Negative ◽

Nosocomial Bacteremia ◽

Appropriate Therapy ◽

Colonization Status

AbstractObjective:Timely initiation of antibiotic therapy is crucial for severe infection. Appropriate antibiotic therapy is often delayed for nosocomial infections caused by antibiotic-resistant bacteria. The relationship between knowledge of colonization caused by antibiotic-resistant gram-negative bacteria (ABR-GNB) and rate of appropriate initial antibiotic therapy for subsequent bacteremia was evaluated.Design:Retrospective cohort study.Setting:Fifty-four-bed intensive care unit (ICU) of a university hospital. In this unit, colonization surveillance is performed through routine site-specific surveillance cultures (urine, mouth, trachea, and anus). Additional cultures are performed when presumed clinically relevant.Patients:ICU patients with nosocomial bacteremia caused by ABR-GNB.Results:Infectious and microbiological characteristics and rates of appropriate antibiotic therapy were compared between patients with and without colonization prior to bacteremia. Prior colonization was defined as the presence (detected ≥ 2 days before the onset of bacteremia) of the same ABR-GNB in colonization and subsequent blood cultures. During the study period, 157 episodes of bacteremia caused by ABR-GNB were suitable for evaluation. One hundred seventeen episodes of bacteremia (74.5%) were preceded by colonization. Appropriate empiric antibiotic therapy (started within 24 hours) was administered for 74.4% of these episodes versus 55.0% of the episodes that occurred without prior colonization. Appropriate therapy was administered within 48 hours for all episodes preceded by colonization versus 90.0% of episodes without prior colonization.Conclusion:Knowledge of colonization status prior to infection is associated with higher rates of appropriate therapy for patients with bacteremia caused by ABR-GNB (Infect Control Hosp Epidemiol 2005;26:575-579).

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Prevalence of Clostridioides difficile Infection in Critically Ill Patients with Extreme Leukocytosis and Diarrhea

Infectious Disease Reports ◽

10.3390/idr13010003 ◽

2021 ◽

Vol 13 (1) ◽

pp. 18-22

Author(s):

Bijan Teja ◽

Nafeesa Alibhai ◽

Gordon D. Rubenfeld ◽

Linda R. Taggart ◽

Naheed Jivraj ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Clostridium Difficile ◽

Critically Ill ◽

Critically Ill Patients ◽

Empiric Antibiotic Therapy ◽

Empiric Treatment ◽

Clostridioides Difficile ◽

Empiric Antibiotic ◽

Clostridioides Difficile Infection

While early empiric antibiotic therapy is beneficial for patients presenting with sepsis, the presentation of sepsis from Clostridioides difficile (formerly Clostridium difficile) infection (CDI) has not been well studied in large cohorts. We sought to determine whether the combination of extreme leukocytosis and diarrhea was strongly predictive of CDI in a cohort of 8659 patients admitted to the intensive care unit. We found that CDI was present in 15.0% (95% CI, 12.1–18.3%) of patients with extreme leukocytosis and diarrhea and that mortality for those with CDI, diarrhea, and extreme leukocytosis was 33.8% (95% CI, 23.2–44.3%). These data support consideration of empiric treatment for CDI in unstable critically ill patients with extreme leukocytosis and diarrhea, along with treatment of other possible sources of sepsis as appropriate. Empiric treatment for CDI can usually be discontinued promptly, along with narrowing of other broad-spectrum antimicrobial coverage, if a sensitive C. difficile test is negative.

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Early empirical antimicrobial therapy does not prevent sepsis development in critically ill surgical patients with suspected nosocomial infection: a retrospective analysis

10.21203/rs.2.22684/v1 ◽

2020 ◽

Author(s):

Estêvão Bassi ◽

Bruno Martins Tomazini ◽

Bárbara Vieira Carneiro ◽

Amanda Rodrigues de Oliveira Siqueira ◽

Sara Rodrigues de Oliveira Siqueira ◽

...

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Nosocomial Infection ◽

Antibiotic Therapy ◽

Primary Outcome ◽

Surgical Patients ◽

Empiric Antibiotic Therapy ◽

Conservative Group ◽

Empiric Antibiotic ◽

Obvious Source

Abstract Background: Early administration of antibiotics to septic shock patients decreases in-hospital mortality, but there is a lack of studies evaluating the role of early empirical antibiotics in surgical patients with suspected nosocomial infection without sepsis. Methods: Retrospective cohort of adult patients admitted to a surgical Intensive Care Unit in a tertiary hospital. We defined early empirical antibiotic group by the initiation of antibiotic therapy within 24h after infection’s suspicion, and conservative group by antibiotic therapy initiation 24 hours after infection’s suspicion or not prescribed within 14 days. The primary outcome was a composite of death, septic shock or sepsis within 14 days from the clinical suspicion of infection. Regression models were used to identify associations between factors and the primary outcome. Results: From 2007 patients admitted to intensive care unit, 341 surgical patients (71% trauma patients) with suspected nosocomial infection without sepsis and with no obvious source of infection were included in the cohort. Age, gender, traumatic brain injury, admission type (trauma vs. non-trauma), SAPS 3, SOFA, vasopressor use or rate of mechanical ventilation did not differ between early empirical antibiotic and conservative groups. In the conservative group, 57% of patients received antibiotics within 14 days. The composite primary outcome occurred in 41% of patients in the conservative group and 56% in the early empirical antimicrobial group, (p=0.007). The 14-day incidence of septic shock or mortality was similar in both groups. Multivariate analysis showed early antimicrobial therapy (OR 1.83 [95% CI 1.16-2.88] , p = 0.008), non-trauma admission (OR 2.32 [1.40-3.90], p = 0.001) and mechanical ventilation (OR 2.09 [1.31-3.35], p = 0.002) were associated with the primary outcome. Exploratory analysis including only patients with positive cultures also did not find any benefit of early empiric antibiotic therapy (OR 1.39 [0.78-2.49], p = 0.26) Conclusions: Early empiric antibiotic therapy does not decrease the incidence of sepsis, septic shock or death within 14 days in critically ill stable surgical patients with suspected infection but with no obvious source.

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Antibiotic Use in the Intensive Care Unit: Optimization and De-Escalation

Journal of Intensive Care Medicine ◽

10.1177/0885066618762747 ◽

2018 ◽

Vol 33 (12) ◽

pp. 647-655 ◽

Cited By ~ 21

Author(s):

Maureen Campion ◽

Gail Scully

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Antibiotic Therapy ◽

Antimicrobial Stewardship ◽

Signs And Symptoms ◽

Antibiotic Use ◽

Multidrug Resistant ◽

Adverse Outcomes ◽

Empiric Antibiotic Therapy ◽

Antibiotic Failure

Appropriate antimicrobial therapy is essential to ensuring positive patient outcomes. Inappropriate or suboptimal utilization of antibiotics can lead to increased length of stay, multidrug-resistant infections, and mortality. Critically ill intensive care patients, particularly those with severe sepsis and septic shock, are at risk of antibiotic failure and secondary infections associated with incorrect antibiotic use. Through the initiation of active empiric antibiotic therapy based upon local susceptibilities, daily evaluation of signs and symptoms of infection and narrowing of antibiotic therapy when feasible, providers can streamline the treatment of common intensive care unit (ICU) infections. Optimizing antibiotic dosing through prolonged infusions can be beneficial in intensive care populations with altered pharmacokinetics. Antimicrobial stewardship teams can assist ICU providers in managing and implementing these tactics. This review will discuss the current literature on antibiotic use in the ICU applying antimicrobial stewardship strategies. Based upon the most recent evidence, ICUs would benefit from employing empiric guidelines for antibiotic use, collecting appropriate specimens and implementing molecular diagnostics, optimizing the dosing of antibiotics, and reducing the duration of total therapy. These strategies for antibiotic use have the potential to enhance patient care while preventing adverse outcomes.

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Time to blood, respiratory and urine culture positivity in the intensive care unit: Implications for de-escalation

SAGE Open Medicine ◽

10.1177/20503121211040702 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110407

Author(s):

Lindsey A Sellers ◽

Kathryn M Fitton ◽

Margaret F Segovia ◽

Christy C Forehand ◽

Kevin K Dobbin ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Urine Culture ◽

Culture Collection ◽

Empiric Antibiotic Therapy ◽

Empiric Antibiotic ◽

Sensitivity Specificity

Objectives: Concern for late detection of bacterial pathogens is a barrier to early de-escalation efforts. The purpose of this study was to assess blood, respiratory and urine culture results at 72 h to test the hypothesis that early negative culture results have a clinically meaningful negative predictive value. Methods: We retrospectively reviewed all patients admitted to the medical intensive care unit between March 2012 and July 2018 with blood cultures obtained. Blood, respiratory and urine culture results were assessed for time to positivity, defined as the time between culture collection and preliminary species identification. The primary outcome was the negative predictive value of negative blood culture results at 72 h. Secondary outcomes included sensitivity, specificity, positive predictive value and negative predictive value of blood, respiratory and urine culture results. Results: The analysis included 1567 blood, 514 respiratory and 1059 urine cultures. Of the blood, respiratory and urine cultures ultimately positive, 90.3%, 76.2% and 90.4% were positive at 72 h. The negative predictive value of negative 72-h blood, respiratory and urine cultures were 0.99, 0.82 and 0.97, respectively. Antibiotic de-escalation had good specificity, positive predictive value and negative predictive value for finalized negative cultures. Conclusion: Negative blood and urine culture results at 72 h had a high negative predictive value. These findings have important ramifications for antimicrobial stewardship efforts and support protocolized re-evaluation of empiric antibiotic therapy at 72 h. Caution should be used in patients with clinically suspected pneumonia, since negative respiratory culture results at 72 h were weakly predictive of finalized negative cultures.

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Faculty Opinions recommendation of Impact of a rotating empiric antibiotic schedule on infectious mortality in an intensive care unit.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1018460.208519 ◽

2004 ◽

Author(s):

Daniel Dykhuizen

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Empiric Antibiotic

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