title: Effects of a simple protocol on infective complications in intensive care unit patients undergoing percutaneous dilatational tracheostomy.
abstract: 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).
authors.affiliation: Department of Anaesthesia and Intensive Care, Riyadh Armed Forces Hospital, Kingdom of Saudi Arabia. sydney@nesma.net.sa.
authors.forename: Sydney
authors.initials: S
authors.lastname: Jacobs
authors.forename: Abdul Mohsen
authors.initials: AM
authors.lastname: Al Rasheed
authors.forename: Wadood
authors.initials: W
authors.lastname: Abdulsamat
authors.forename: Ali
authors.initials: A
authors.lastname: Al Barrak
authors.forename: Nasser Fawzan
authors.initials: NF
authors.lastname: Al Omer
authors.forename: David
authors.initials: D
authors.lastname: Tjan
authors.forename: Mehrun
authors.initials: M
authors.lastname: Zuleika
authors.forename: Faham
authors.initials: F
authors.lastname: Ahmed
authors.forename: Mushera
authors.initials: M
authors.lastname: Enani
mesh_terms: 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