Effects of a simple protocol on infective complications in intensive care unit patients undergoing percutaneous dilatational tracheostomy.
In our intensive care unit we monitored infection in 228 patients who underwent percutaneous dilatational tracheostomy (PDT). In the first phase of the study 128 PDTs were performed during a 33-month period and there were 41 infection complications (nosocomial pneumonia, bacteremia with sepsis, and septic shock) in the perioperative period (immediately prior to and for 5 days after PDT). A significant risk factor among patients with nosocomial pneumonia was empirical administration of inappropriate antibiotics, compared to appropriate antibiotics (34% versus 4%, p < 0.001). In the second phase of the study (a 30-month period), a simple antibiotics protocol was prospectively applied to 100 PDT patients. The protocol virtually eliminated inappropriate antibiotic drug use immediately prior to PDT and contributed to a significant reduction in perioperative infective complications (pre-protocol 32% versus protocol 11%, p < 0.001).
Jacobs
Sydney
S
Department of Anaesthesia and Intensive Care, Riyadh Armed Forces Hospital, Kingdom of Saudi Arabia. sydney@nesma.net.sa.
Al Rasheed
Abdul Mohsen
AM
Abdulsamat
Wadood
W
Al Barrak
Ali
A
Al Omer
Nasser Fawzan
NF
Tjan
David
D
Zuleika
Mehrun
M
Ahmed
Faham
F
Enani
Mushera
M
D000328:Adult; D019072:Antibiotic Prophylaxis; D016470:Bacteremia / Q000517:prevention & control*; D003428:Cross Infection / Q000517:prevention & control*; D004106:Dilatation; D005260:Female; D006801:Humans; D017053:Infection Control; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000517:prevention & control; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000517:prevention & control*; D012307:Risk Factors; D014139:Tracheostomy