Audit of bacteraemia management in a university hospital ICU

Abstract

Introduction The optimal duration of antibiotic treatment in critically ill patients remains a subject of debate. In our multidisciplinary ICU, a short course of antibiotic monotherapy (5 to 7 days) is generally used as a strategy to treat bacteraemia, unless specifically indicated otherwise (for example, endocarditis, osteomyelitis). We aimed to determine the impact of this strategy on antibiotic resistance patterns and patient outcomes compared with a similar exercise we conducted in 2000 [1]. Methods We conducted a retrospective study of all patients with bacteraemia or fungaemia (community-acquired, hospital-acquired, and ICU-acquired) treated in our university hospital ICU over a 6-month period (December 2012 to May 2013). We compared this against data from blood culture-positive patients admitted between February and July 2000. Information was collected on bacteraemia episodes, causative pathogens, antimicrobial resistance patterns, antibiotic use and duration, and patient outcomes. Notably, our ICU admits many immunosuppressed patients (for example, haemoncology). Results Table 1 presents demographics and incidence of bacteraemia. Antimicrobial resistance remained low in the 2013 cohort with few multi-resistant Gram-negative organisms, few fungaemia episodes and a marked decrease in methicillin-resistant Staphylococcus aureus (MRSA) (Figure 1). The number of relapses and breakthrough bacteraemias remained low. Conclusion A strategy of short-course antibiotic monotherapy is associated with low breakthrough and relapse rates and a low rate of antibiotic resistance. (Figure Presented).