title: Effect of an intensive care unit rotating empiric antibiotic schedule on the development of hospital-acquired infections on the non-intensive care unit ward.
abstract: OBJECTIVE
  We have previously shown that a rotating empirical antibiotic schedule could reduce infectious mortality in an intensive care unit (ICU). We hypothesized that this intervention would decrease infectious complications in the non-ICU ward to which these patients were transferred.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  An ICU and the ward to which the ICU patients were transferred at a university medical center.
  
  
  METHODS
  All patients treated on the general, transplant, or trauma surgery services who developed hospital-acquired infection while on the non-ICU wards.
  
  
  METHODS
  A 2-yr study consisting of 1-yr non-protocol-driven antibiotic use and 1-yr quarterly rotating empirical antibiotic assignment for patients treated in the ICU from which a portion of the patients were transferred.
  
  
  RESULTS
  There were 2,088 admissions to the non-ICU wards during the nonrotation year and 2,183 during the ICU rotation year. Of these patients, 407 hospital-acquired infections were treated during the nonrotation year and 213 were treated during the ICU rotation (19.7 vs. 9.8 infections/100 admissions, p <.0001). During the ICU rotation year a decrease in the rate of resistant Gram-positive and resistant Gram-negative infections on the non-ICU wards occurred (2.5 vs. 1.6 infections/100 admissions, p =.04; 1.0 vs. 0.4 infections/100 admissions, p =.03). Subgroup analysis revealed that the decrease in resistant infections on the wards was due to a reduction in resistant Gram-positive and resistant Gram-negative infections among non-ICU ward patients admitted initially from areas other than the ICU implementing the antibiotic rotation (e.g., home, other ward, or a different ICU) (1.8 vs. 0.5 infections/100 admissions, p =.0001; 0.7 vs. 0.2 infections/100 admissions, p =.02), not due to differences for those transferred to the ward from the rotation ICU (10.4 vs. 9.7 infections/100 admissions, p = 1.0; 4.3 vs. 1.9 infections/100 admissions, p =.3). No differences in infection-related mortality were detected.
  
  
  CONCLUSIONS
  An effective rotating empirical antibiotic schedule in an ICU is associated with a reduction in infectious morbidity (hospital-acquired and resistant hospital-acquired infection rates) on the non-ICU wards to which patients are transferred.
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville 22908, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hughes
authors.forename: Heather L
authors.initials: HL
authors.lastname: Evans
authors.forename: Tae W
authors.initials: TW
authors.lastname: Chong
authors.forename: Robert L
authors.initials: RL
authors.lastname: Smith
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Raymond
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Pelletier
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Pruett
authors.forename: Robert G
authors.initials: RG
authors.lastname: Sawyer
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D015331:Cohort Studies; D003428:Cross Infection / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control*; D004334:Drug Administration Schedule; D004352:Drug Resistance, Microbial; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006757:Hospital Units; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D010360:Patient Transfer; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents