title: Prospective audit of bacteraemia management in a university hospital ICU using a general strategy of short-course monotherapy.
abstract: OBJECTIVE
  As optimal antibiotic therapy for bacteraemia remains unknown, different strategies have evolved. Routine practice in the University College London Hospitals intensive care unit (ICU) is to use short-course (5-6 days) monotherapy, unless specifically indicated (e.g. endocarditis, osteomyelitis). We decided to assess this approach for treating community-, hospital-, and ICU-acquired bacteraemia by monitoring clinical response, relapse rate and patient outcome.
  
  
  METHODS
  Six-month prospective observational study from February to July 2000.
  
  
  METHODS
  Mixed medical-surgical tertiary referral ICU.
  
  
  METHODS
  All 713 patients admitted to the ICU over the study period.
  
  
  RESULTS
  In total, 102 bacteraemic episodes occurred in 84 patients. Eight (57%) of 14 community-acquired bacteraemias, 22 (79%) of 28 hospital-acquired bacteraemias, and 48 (80%) of 60 ICU-acquired bacteraemias (in 49 patients) were treated with short-course monotherapy. Compared with previous reported studies, these patients had a low rate (23.8%) of death directly attributable to the bacteraemia and a satisfactory clinical response in 72%. Of six relapses (all Gram-negative), four had received combination therapy for severe deep-seated infections. ICU-acquired multidrug-resistant Gram-negative bacteraemias (6.5%) and fungaemias (3%) were also uncommon. No patient discharged from ICU subsequently developed a new bacteraemia relapse, or any long-term complication such as osteomyelitis.
  
  
  CONCLUSIONS
  Our general strategy of short-course antibiotic monotherapy for treating bacteraemia in the critically ill appears to provide a satisfactory clinical response, low relapse rate and no long-term complications in a well-defined group of patients. Multicentre studies are warranted to compare short versus long course therapy, and monotherapy versus combination therapy.
authors.affiliation: Bloomsbury Institute of Intensive Care Medicine, University College London, Jules Thorn Building, Middlesex Hospital, Mortimer Street, London W1N 3AA. corona.alberto@libero.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Corona
authors.forename: A Peter R
authors.initials: AP
authors.lastname: Wilson
authors.forename: Mario
authors.initials: M
authors.lastname: Grassi
authors.forename: Mervyn
authors.initials: M
authors.lastname: Singer
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents