Routine microbiological screening in septic patients in a cardiac surgical intensive care unit.
BACKGROUND
Patients in a surgical intensive care unit (ICU) have a high incidence of nosocomial infections which often lead to septic shock and death. Since specific antibiotic treatment is often difficult, it is recommended that routine nose/throat swabs be obtained in order to have a better idea of the causative agent when a systemic inflammatory response occurs in a given patient.


METHODS
In 1435 patients in a cardiac surgical ICU, routine nose/throat swabs were taken thrice a week and tested for microorganisms and systemic inflammation. Blood cultures were also obtained. Antibiotic treatment was given to cover the microbes from the nose/throat swabs. Alternatively, an empirical antibiotic therapy was given to patients whose swabs had tested negative.


RESULTS
Of the 86 patients with systemic inflammation, 29 had blood cultures positive for microbes. Of these, 18 received a specific antibiotic therapy based on their positive nose/throat cultures prior to the return of the blood cultures from the laboratory. However, only 11 patients tested positive for the same microbes on routine swabs and blood cultures. While positive routine swabs are quite specific to sepsis when there is a systemic inflammatory response, routine swabs are not a suitable screening tool due to their low sensitivity.


CONCLUSIONS
Routine nose/throat swabs led to earlier specific antibiotic treatment in only 22 % of patients with clinical signs of systemic inflammation. In 36 % of cases, the organisms detected in the routine swabs and blood cultures were not identical. Hence, we believe that routine swabs are of limited value in instituting earlier, specific antibiotic therapy in septic patients.
Meininger
D
D
Department of Anesthesiology, Intensive Care Medicine and Pain Control, JW Goethe-University Hospital, Frankfurt, Germany.
Byhahn
C
C
Maeser
D
D
Martens
S
S
Westphal
K
K
D019072:Antibiotic Prophylaxis; D006348:Cardiac Surgical Procedures; D003422:Critical Care; D003428:Cross Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D009666:Nose / Q000382:microbiology; D010614:Pharynx / Q000382:microbiology; D018805:Sepsis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D015996:Survival Rate; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality