• Am. J. Surg. · Mar 2016

    Impact of inappropriate initial antibiotics in critically ill surgical patients with bacteremia.

    • Katri Abraham, Heather S Dolman, Lisa Hall Zimmerman, Janie Faris, David A Edelman, Alfred Baylor, Robert F Wilson, and James G Tyburski.
    • Department of Pharmacy Services, Detroit Receiving Hospital, Wayne State University, Detroit, MI, USA.
    • Am. J. Surg. 2016 Mar 1; 211 (3): 593-8.

    BackgroundBloodstream 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.MethodsThis 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.ResultsIn 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.ConclusionsAAT selection is imperative in critically patients with bacteremia to reduce the significant impact of inappropriate selection. Repeated episodes of bacteremia should receive special attention.Copyright © 2016 Elsevier Inc. All rights reserved.

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