title: Impact of inappropriate initial antibiotics in critically ill surgical patients with bacteremia.
abstract: BACKGROUND
  Bloodstream infections in critically ill patients are associated with mortality as high as 60% and a prolonged hospital stay. We evaluated the impact of inappropriate antibiotic therapy (IAAT) in a critically ill surgical cohort with bacteremia.
  
  
  METHODS
  This retrospective study evaluated adults with intensive care unit admission greater than 72 hours and bacteremia. Two groups were evaluated: appropriate antibiotic therapy (AAT) vs IAAT.
  
  
  RESULTS
  In 72 episodes of bacteremia, 57 (79%) AAT and 15 (21%) IAAT, mean age was 54 ± 17 years and APACHE II of 17 ± 8. Time to appropriate antibiotics was longer for IAAT (3 ± 5 IAAT vs 1 ± 1 AAT days, P = .003). IAAT was seen primarily with Acinetobacter spp (33% IAAT vs 9% AAT, P = .01) and Enterococcus faecium (26% IAAT vs 7% AAT, P = .03). If 2 or more bacteremic episodes occurred, Acinetobacter spp. was more likely, 32% vs 2%, P = .001.
  
  
  CONCLUSIONS
  AAT selection is imperative in critically patients with bacteremia to reduce the significant impact of inappropriate selection. Repeated episodes of bacteremia should receive special attention.
authors.affiliation: Department of Pharmacy Services, Detroit Receiving Hospital, Wayne State University, Detroit, MI, USA.
authors.forename: Katri
authors.initials: K
authors.lastname: Abraham
authors.affiliation: Michael and Marian Ilitch Department of Surgery, Detroit Receiving Hospital, 4201 St. Antoine Blvd, Suite 4S-13, Wayne State University, Detroit, MI 48201, USA. Electronic address: hdolman@med.wayne.edu.
authors.forename: Heather S
authors.initials: HS
authors.lastname: Dolman
authors.affiliation: Department of Pharmacy Services, Detroit Receiving Hospital, Wayne State University, Detroit, MI, USA.
authors.forename: Lisa Hall
authors.initials: LH
authors.lastname: Zimmerman
authors.affiliation: Department of Pharmacy Services, Detroit Receiving Hospital, Wayne State University, Detroit, MI, USA.
authors.forename: Janie
authors.initials: J
authors.lastname: Faris
authors.affiliation: Michael and Marian Ilitch Department of Surgery, Harper University Hospital, Wayne State University, Detroit, MI, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Edelman
authors.affiliation: Michael and Marian Ilitch Department of Surgery, Detroit Receiving Hospital, 4201 St. Antoine Blvd, Suite 4S-13, Wayne State University, Detroit, MI 48201, USA.
authors.forename: Alfred
authors.initials: A
authors.lastname: Baylor
authors.affiliation: Michael and Marian Ilitch Department of Surgery, Detroit Receiving Hospital, 4201 St. Antoine Blvd, Suite 4S-13, Wayne State University, Detroit, MI 48201, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Wilson
authors.affiliation: Michael and Marian Ilitch Department of Surgery, Detroit Receiving Hospital, 4201 St. Antoine Blvd, Suite 4S-13, Wayne State University, Detroit, MI 48201, USA.
authors.forename: James G
authors.initials: JG
authors.lastname: Tyburski
mesh_terms: D018806:APACHE; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D057970:Inappropriate Prescribing; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Appropriate; Bacteremia; Critically ill; Surgery