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

Published online by Cambridge University Press:  21 June 2016

Stijn Blot ,
Pieter Depuydt ,
Dirk Vogelaers ,
Johan Decruyenaere ,
Jan De Waele ,
Eric Hoste ,
Renaat Peleman ,
Geert Claeys ,
Gerda Verschraegen  and
Francis Colardyn
...Show all authors
Stijn Blot*
Affiliation:
Department of Intensive Care, Ghent University Hospital, Gent, Belgium
Pieter Depuydt
Affiliation:
Department of Intensive Care, Ghent University Hospital, Gent, Belgium
Dirk Vogelaers
Affiliation:
Department of Infectious Diseases, Ghent University Hospital, Gent, Belgium
Johan Decruyenaere
Affiliation:
Department of Intensive Care, Ghent University Hospital, Gent, Belgium
Jan De Waele
Affiliation:
Department of Intensive Care, Ghent University Hospital, Gent, Belgium
Eric Hoste
Affiliation:
Department of Intensive Care, Ghent University Hospital, Gent, Belgium
Renaat Peleman
Affiliation:
Department of Infectious Diseases, Ghent University Hospital, Gent, Belgium
Geert Claeys
Affiliation:
Department of Microbiology, Ghent University Hospital, Gent, Belgium
Gerda Verschraegen
Affiliation:
Department of Microbiology, Ghent University Hospital, Gent, Belgium
Francis Colardyn
Affiliation:
Department of Intensive Care, Ghent University Hospital, Gent, Belgium
Koenraad Vandewoude
Affiliation:
Department of Intensive Care, Ghent University Hospital, Gent, Belgium
*
Ghent University Hospital, Intensive Care Dept., De Pintelaan 185, B-9000 Gent, Belgium.[email protected]
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Abstract

Objective:

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.

Design:

Retrospective cohort study.

Setting:

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.

Patients:

ICU patients with nosocomial bacteremia caused by ABR-GNB.

Results:

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 ≥ 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.

Conclusion:

Knowledge of colonization status prior to infection is associated with higher rates of appropriate therapy for patients with bacteremia caused by ABR-GNB (Infect Control Hosp Epidemiol 2005;26:575-579).

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 6 , June 2005 , pp. 575 - 579
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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