Impact of a rotating empiric antibiotic schedule on infectious mortality in an intensive care unit
Impact of a rotating empiric antibiotic schedule on infectious mortality in an intensive care unit
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DOI：
10.1097/00003246-200106000-00001
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发表时间：
2001-06-01
影响因子：
8.8
通讯作者：
Sawyer, RG
中科院分区：
文献类型：
--
作者：
Raymond, DP;Pelletier, SJ;Sawyer, RG
目的：耐药菌的发展与危重患者的发病率和死亡率相关。我们假设每季度轮换使用经验性抗生素可以减少重症监护病房（ICU）耐药菌的感染并发症。设计：前瞻性队列研究。大学医疗中心的重症监护室。研究对象：所有在普通外科、移植外科或创伤外科就诊的发生肺炎、腹膜炎或不明原因败血症的患者。干预措施：一项为期2年的研究，包括1年的非协议驱动抗生素使用和1年的轮换经验性抗生素分配。测量和主要结果：每次感染事件记录了100多个变量，包括患者特征（如急性生理和慢性健康评估[APACHE] II评分、年龄、合并症）、感染特征（如部位、生物体）、治疗特征（如抗生素、治疗持续时间）和结局指标（如死亡率、住院时间、抗生素费用）。在ICU连续收治的1456例患者中，540例感染得到了治疗。在2年的研究中，年龄、APACHE II评分、种族、总体抗生素使用或治疗持续时间没有差异。结果分析显示，轮转期间抗生素耐药革兰氏阳性球菌感染（7.8例感染/100例对14.6例感染/100例，p < 0.0001）、抗生素耐药革兰氏阴性杆菌感染（2.5例感染/100例对7.7例感染/100例，p < 0.0001）和与感染相关的死亡率（2.9例死亡/100例对9.6例死亡/100例，p < 0.0001）的发生率显著降低。Logistic回归发现年龄（优势比[OR]， 1.03； 95%可信区间[CI]， 1.01-1.06）、APACHE II评分（OR, 1.06; 95% CI, 1.01-1.13）、实体器官移植（OR, 9.50; 95% CI, 2.01-52.21）和恶性肿瘤（OR, 10.16; 95% CI, 4.11-26.96）是死亡率的独立预测因素。抗生素轮转是生存的独立预测因子（OR 6.27, 95% CI 2.78-14.16）。结论：轮转经验性抗生素治疗似乎是降低ICU感染性死亡率的一种有希望的方法。
Objective: The development of antibiotic-resistant bacteria is associated with significant morbidity and mortality in critically ill patients. We postulated that quarterly rotation of empirical antibiotics could decrease infectious complications from resistant organisms in an intensive care unit (ICU).Design: Prospective cohort study.Setting. An ICU at a university medical center.Subjects: AII patients admitted to the general, transplant, or trauma surgery services who developed pneumonia, peritonitis, or sepsis of unknown origin.Interventions: A 2-yr study consisting of 1 yr of nonprotacol-driven antibiotic use and 1 yr of rotating empirical antibiotic assignment.Measurements and Main Results: Over 100 variables were recorded for each infectious episode, including patient characteristics (e.g., Acute Physiology and Chronic Health Evaluation [APACHE] II score, age, comorbidities), infection characteristics (e.g., site, organism), treatment characteristics (e.g., antibiotic, treatment duration) and outcome measures (e.g., mortality, length of stay, antibiotic cost). Of 1456 consecutive admissions to the ICU, 540 episodes of infection were treated. No differences were noted in age, APACHE II score, race, overall antibiotic utilization or duration of therapy between the 2 yrs of study. Outcome analysis revealed significant reductions in the incidence of antibiotic-resistant Gram-positive coccal infections (7.8 infections/100 admissions vs. 14.6 infections/100 admissions, p < .0001), antibiotic-resistant Gram-negative bacillary infections (2.5 infections/100 admissions vs. 7.7 infections/100 admissions, p < .0001), and mortality associated with infection (2.9 deaths/100 admissions vs. 9.6 deaths/100 admissions, p < .0001) during rotation. Logistic regression identified age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.06), APACHE II score (OR, 1.06; 95% CI, 1.01-1.13), solid organ transplantation (OR, 9.50; 95% CI, 2.01-52.21), and malignancy (OR, 10.16; 95% CI, 4.11-26.96) as independent predictors of mortality. Antibiotic rotation was an independent predictor of survival (OR 6.27, 95% CI 2.78-14.16),Conclusion: Rotation of empirical antibiotic therapy seems to be a promising method to reduce infectious mortality in an ICU.