title: Empiric therapy of sepsis in the surgical intensive care unit with broad-spectrum antibiotics for 72 hours does not lead to the emergence of resistant bacteria.
abstract: BACKGROUND
  It is our practice to treat suspected sepsis with imipenem/cilastatin and gentamicin (IMP/GENT) for 72 hours while awaiting culture results. We wanted to determine if this practice engenders antimicrobial resistance.
  
  
  METHODS
  Review of prospectively collected data regarding use of IMP/GENT and microbial sensitivity to imipenem/cilastatin during the first and last 7 months of a 19-month study period (October 1, 1995, to April 30, 1997).
  
  
  RESULTS
  The susceptibility of appropriate organisms to imipenem/cilastatin was 76% in the early period and 80% in the late period (p = 0.42). Pseudomonas aeruginosa was more susceptible in the late period (88 vs. 62%; p = 0.007). Resistance to gentamicin (30% early vs. 21% late; p = 0.02) and representative cephalosporins (cefoxitin, 52% early vs. 61% late; p = 0.35; ceftazidime, 26% early vs. 23% late; p = 0.76) did not develop during the study period. The incidence of fungemia was the same in both periods (4 of 467 admissions vs. 3 of 599 admissions; p = 0.48).
  
  
  CONCLUSIONS
  This protocol did not lead to the emergence of resistant bacteria.
authors.affiliation: University of Miami School of Medicine, Jackson Memorial Hospital, FL 33101, USA.
authors.forename: N
authors.initials: N
authors.lastname: Namias
authors.forename: S
authors.initials: S
authors.lastname: Harvill
authors.forename: S
authors.initials: S
authors.lastname: Ball
authors.forename: M G
authors.initials: MG
authors.lastname: McKenney
authors.forename: J P
authors.initials: JP
authors.lastname: Salomone
authors.forename: D
authors.initials: D
authors.lastname: Sleeman
authors.forename: J M
authors.initials: JM
authors.lastname: Civetta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D003422:Critical Care; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination / Q000009:adverse effects*; D019348:Empiricism; D005260:Female; D005839:Gentamicins / Q000009:adverse effects*; D006801:Humans; D015378:Imipenem / Q000009:adverse effects*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000188:drug therapy* / Q000382:microbiology; D013845:Thienamycins / Q000009:adverse effects*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D013845:Thienamycins; D015378:Imipenem