Colonization Status and Appropriate Antibiotic Therapy for Nosocomial Bacteremia Caused by Antibiotic‐Resistant Gram‐Negative Bacteria in an Intensive Care Unit

• Published in: Infection control and hospital epidemiology 2005-06, Vol.26 (6), p.575-579
• Main Authors: Blot, Stijn, Depuydt, Pieter, Vogelaers, Dirk, Decruyenaere, Johan, Waele, Jan De, Hoste, Eric, Peleman, Renaat, Claeys, Geert, Verschraegen, Gerda, Colardyn, Francis, Vandewoude, Koenraad
• Format: Article
• Language: English
• Subjects: Anal Canal - microbiology; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotic resistance; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antimicrobials; Bacteremia; Bacteremia - diagnosis; Bacteremia - drug therapy; Bacteremia - epidemiology; Bacteremia - microbiology; Bacteria; Bacterial diseases; Bacterial sepsis; Belgium - epidemiology; Biological and medical sciences; Clinical Protocols - standards; Colonization; Cost-Benefit Analysis; Critical Care - economics; Critical Care - methods; Critical Care - standards; Cross Infection - diagnosis; Cross Infection - drug therapy; Cross Infection - epidemiology; Cross Infection - microbiology; Drug Resistance, Bacterial; General aspects; Gram negative bacteria; Gram-Negative Bacterial Infections - diagnosis; Gram-Negative Bacterial Infections - drug therapy; Gram-Negative Bacterial Infections - epidemiology; Gram-Negative Bacterial Infections - microbiology; Health outcomes; Hospitals, University; Human bacterial diseases; Human infectious diseases. Experimental studies and models; Humans; Incidence; Infection Control - economics; Infection Control - methods; Infection Control - standards; Infections; Infectious diseases; Intensive care units; Length of Stay - statistics & numerical data; Medical sciences; Microbial Sensitivity Tests; Mouth - microbiology; Nosocomial infection; Nursing; Original Articles; Patient Selection; Patient surveillance; Pharmacology. Drug treatments; Predictive Value of Tests; Retrospective Studies; Specimen Handling - economics; Specimen Handling - methods; Specimen Handling - standards; Surveillance; Time Factors; Trachea - microbiology; Urine - microbiology
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1086/502575

Timely initiation of antibiotic therapy is crucial for severe infection. Appropriate antibiotic therapy is often delayed for nosocomial infections caused by antibiotic-resistant bacteria. The relationship between knowledge of colonization caused by antibiotic-resistant gram-negative bacteria (ABR-GNB) and rate of appropriate initial antibiotic therapy for subsequent bacteremia was evaluated. Retrospective cohort study. Fifty-four-bed intensive care unit (ICU) of a university hospital. In this unit, colonization surveillance is performed through routine site-specific surveillance cultures (urine, mouth, trachea, and anus). Additional cultures are performed when presumed clinically relevant. ICU patients with nosocomial bacteremia caused by ABR-GNB. Infectious and microbiological characteristics and rates of appropriate antibiotic therapy were compared between patients with and without colonization prior to bacteremia. Prior colonization was defined as the presence (detected > or = 2 days before the onset of bacteremia) of the same ABR-GNB in colonization and subsequent blood cultures. During the study period, 157 episodes of bacteremia caused by ABR-GNB were suitable for evaluation. One hundred seventeen episodes of bacteremia (74.5%) were preceded by colonization. Appropriate empiric antibiotic therapy (started within 24 hours) was administered for 74.4% of these episodes versus 55.0% of the episodes that occurred without prior colonization. Appropriate therapy was administered within 48 hours for all episodes preceded by colonization versus 90.0% of episodes without prior colonization. Knowledge of colonization status prior to infection is associated with higher rates of appropriate therapy for patients with bacteremia caused by ABR-GNB.