Colonization status and appropriate antibiotic therapy for nosocomial bacteremia caused by antibiotic-resistant gram-negative bacteria in an intensive care unit.
OBJECTIVE
Timely initiation of antibiotic therapy is crucial for severe infection. Appropriate antibiotic therapy is often delayed for nosocomial infections caused by antibiotic-resistant bacteria. The relationship between knowledge of colonization caused by antibiotic-resistant gram-negative bacteria (ABR-GNB) and rate of appropriate initial antibiotic therapy for subsequent bacteremia was evaluated.


METHODS
Retrospective cohort study.


METHODS
Fifty-four-bed intensive care unit (ICU) of a university hospital. In this unit, colonization surveillance is performed through routine site-specific surveillance cultures (urine, mouth, trachea, and anus). Additional cultures are performed when presumed clinically relevant.


METHODS
ICU patients with nosocomial bacteremia caused by ABR-GNB.


RESULTS
Infectious and microbiological characteristics and rates of appropriate antibiotic therapy were compared between patients with and without colonization prior to bacteremia. Prior colonization was defined as the presence (detected > or = 2 days before the onset of bacteremia) of the same ABR-GNB in colonization and subsequent blood cultures. During the study period, 157 episodes of bacteremia caused by ABR-GNB were suitable for evaluation. One hundred seventeen episodes of bacteremia (74.5%) were preceded by colonization. Appropriate empiric antibiotic therapy (started within 24 hours) was administered for 74.4% of these episodes versus 55.0% of the episodes that occurred without prior colonization. Appropriate therapy was administered within 48 hours for all episodes preceded by colonization versus 90.0% of episodes without prior colonization.


CONCLUSIONS
Knowledge of colonization status prior to infection is associated with higher rates of appropriate therapy for patients with bacteremia caused by ABR-GNB.
Blot
Stijn
S
Department of Intensive Care, Ghent University Hospital, Gent, Belgium. stijn.blot@UGent.be
Depuydt
Pieter
P
Vogelaers
Dirk
D
Decruyenaere
Johan
J
De Waele
Jan
J
Hoste
Eric
E
Peleman
Renaat
R
Claeys
Geert
G
Verschraegen
Gerda
G
Colardyn
Francis
F
Vandewoude
Koenraad
K
D001003:Anal Canal / Q000382:microbiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D001530:Belgium / Q000453:epidemiology; D002985:Clinical Protocols / Q000592:standards; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics / Q000379:methods / Q000592:standards; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000191:economics / Q000379:methods / Q000592:standards; D007902:Length of Stay / Q000706:statistics & numerical data; D008826:Microbial Sensitivity Tests; D009055:Mouth / Q000382:microbiology; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013048:Specimen Handling / Q000191:economics / Q000379:methods / Q000592:standards; D013997:Time Factors; D014132:Trachea / Q000382:microbiology; D014556:Urine / Q000382:microbiology
D000900:Anti-Bacterial Agents