title: Bacteraemia incidence, causative organisms and resistance patterns, antibiotic strategies and outcomes in a single university hospital ICU: continuing improvement between 2000 and 2013.
abstract: OBJECTIVE
  The optimal duration of antibiotic treatment in patients with bloodstream infections remains contentious, with concerns regarding both undertreatment and the encouragement of antibiotic resistance. In our ICU we traditionally use short-course antibiotic monotherapy as the mainstay of treatment. We sought to document the impact of this strategy on pathogen type, resistance patterns and patient outcomes. A comparison was made against data collected during a similar exercise in 2000.
  
  
  METHODS
  We retrospectively reviewed data on all patients with community-, hospital- and ICU-acquired bacteraemia over a 6 month period (1 December 2012 to 31 May 2013) in a general medical-surgical ICU in a London university hospital. Causative pathogens, resistance patterns, use and duration of monotherapy or combination therapy, breakthrough and relapse rates, and patient outcomes were assessed.
  
  
  RESULTS
  The 2013 cohort comprised 113 episodes in 87 patients. Short-course monotherapy (median course 4-5 days) was used in 65.7% of episodes (73.5% in 2000). As with the 2000 cohort, the incidence of antimicrobial resistance, fungaemia, bacteraemia breakthrough and relapse remained low. Of note, there was a decreasing incidence of ICU-acquired MRSA, MDR Gram-negative bacteraemia and fluconazole-resistant candidaemia. Hospital mortality was 32% (45% in 2000).
  
  
  CONCLUSIONS
  Our strategy predominantly utilizing short-course antibiotic monotherapy remains effective in achieving good clinical outcomes among patients with bloodstream infections, with low rates of antibiotic resistance and clinical relapse. Prospective trials of short-course monotherapy are warranted to assess clinical efficacy and antimicrobial resistance.
authors.affiliation: Bloomsbury Institute of Intensive Care Medicine, University College London, and Department of Critical Care, UCL Hospitals NHS Foundation Trust, London, UK.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: De Santis
authors.affiliation: Bloomsbury Institute of Intensive Care Medicine, University College London, and Department of Critical Care, UCL Hospitals NHS Foundation Trust, London, UK.
authors.forename: Mihaela
authors.initials: M
authors.lastname: Gresoiu
authors.affiliation: Azienda Ospedaliera Luigi Sacco, University of Milan, via GB Grassi 74, 20157 Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Corona
authors.affiliation: Clinical Microbiology & Virology, UCLH NHS Foundation Trust, London, UK.
authors.forename: A Peter R
authors.initials: AP
authors.lastname: Wilson
authors.affiliation: Bloomsbury Institute of Intensive Care Medicine, University College London, and Department of Critical Care, UCL Hospitals NHS Foundation Trust, London, UK m.singer@ucl.ac.uk.
authors.forename: Mervyn
authors.initials: M
authors.lastname: Singer
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology*; D001419:Bacteria / Q000145:classification* / Q000187:drug effects* / Q000302:isolation & purification; D024881:Drug Resistance, Bacterial; D004358:Drug Therapy / Q000379:methods; D004363:Drug Utilization; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008131:London / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic combination therapy; antibiotic duration; antibiotic monotherapy; antibiotic resistance; fungaemia; intensive care; mortality