title: Long-term adherence to a 5 day antibiotic course guideline for treatment of intensive care unit (ICU)-associated Gram-negative infections.
abstract: OBJECTIVE
  To determine long-term adherence to a 5 day antibiotic course guideline for treating intensive care unit (ICU)-acquired Gram-negative bacteria (GNB) infections.
  
  
  METHODS
  Descriptive analysis of patient-level data on all GNB-active antibiotics prescribed from day 3 and all GNB identified in clinical samples in 5350 patients admitted to a 30 bed general ICU between 2002 and 2009.
  
  
  RESULTS
  Four thousand five hundred and eleven of 5350 (84%) patients were treated with one or more antibiotics active against GNB commenced from day 3. Gentamicin was the most frequently prescribed antibiotic (92.2 days of therapy/1000 patient-days). Only 6% of courses spanned >6 days of therapy and 89% of antibiotic therapy days were with a single antibiotic active against GNB. There was no significant difference between gentamicin and meropenem in the number of first courses in which a resistant GNB was identified in blood cultures [11/1177 (0.9%) versus 5/351 (1.4%); P = 0.43] or respiratory tract specimens [59/951 (6.2%) versus 17/246 (6.9%); P = 0.68] at the time of starting therapy.
  
  
  CONCLUSIONS
  This study demonstrates long-term adherence to a 5 day course antibiotic guideline for treatment of ICU-associated GNB infections. This guideline is a potential antibiotic-sparing alternative to currently recommended dual empirical courses extending to ≥7 days.
authors.affiliation: Centre for Clinical Infection and Diagnostic Research (CIDR), Department of Infectious Diseases, Kings College London and Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK jonathan.edgeworth@gstt.nhs.uk.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Edgeworth
authors.affiliation: Centre for Clinical Infection and Diagnostic Research (CIDR), Department of Infectious Diseases, Kings College London and Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
authors.forename: Irina
authors.initials: I
authors.lastname: Chis Ster
authors.affiliation: School of Medicine, Kings College London and Critical Care, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
authors.forename: Duncan
authors.initials: D
authors.lastname: Wyncoll
authors.affiliation: School of Medicine, Kings College London and Critical Care, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
authors.forename: Manu
authors.initials: M
authors.lastname: Shankar-Hari
authors.affiliation: Institute of Pharmaceutical Sciences, Franklin Wilkins Building, Kings College, London SE1 7RT, UK Department of Pharmacy, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: McKenzie
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D019983:Guideline Adherence; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Gram-negative bacteria; aminoglycosides; antibiotic resistance