JAC Advance Access originally published online on September 16, 2004
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Journal of Antimicrobial Chemotherapy 2004 54(4):809-817; doi:10.1093/jac/dkh416
JAC vol.54 no.4 © The British Society for Antimicrobial Chemotherapy 2004; all rights reserved
Prospective audit of bacteraemia management in a university hospital ICU using a general strategy of short-course monotherapy
1 Bloomsbury Institute of Intensive Care Medicine, University College London, Jules Thorn Building, Middlesex Hospital, Mortimer Street, London W1N 3AA; 2 Department of Clinical Microbiology, University College London Hospitals, London, UK; 3 Dipartimento di Scienze Sanitarie Applicate, Università di Pavia, Pavia, Italy
* Corresponding author. Tel/Fax: +39-0383-805701; Email: corona.alberto{at}libero.it
Objective: As optimal antibiotic therapy for bacteraemia remains unknown, different strategies have evolved. Routine practice in the University College London Hospitals intensive care unit (ICU) is to use short-course (5–6 days) monotherapy, unless specifically indicated (e.g. endocarditis, osteomyelitis). We decided to assess this approach for treating community-, hospital-, and ICU-acquired bacteraemia by monitoring clinical response, relapse rate and patient outcome.
Design: Six-month prospective observational study from February to July 2000.
Setting: Mixed medical-surgical tertiary referral ICU.
Patients: All 713 patients admitted to the ICU over the study period.
Measurements and results: In total, 102 bacteraemic episodes occurred in 84 patients. Eight (57%) of 14 community-acquired bacteraemias, 22 (79%) of 28 hospital-acquired bacteraemias, and 48 (80%) of 60 ICU-acquired bacteraemias (in 49 patients) were treated with short-course monotherapy. Compared with previous reported studies, these patients had a low rate (23.8%) of death directly attributable to the bacteraemia and a satisfactory clinical response in 72%. Of six relapses (all Gram-negative), four had received combination therapy for severe deep-seated infections. ICU-acquired multidrug-resistant Gram-negative bacteraemias (6.5%) and fungaemias (3%) were also uncommon. No patient discharged from ICU subsequently developed a new bacteraemia relapse, or any long-term complication such as osteomyelitis.
Conclusions: Our general strategy of short-course antibiotic monotherapy for treating bacteraemia in the critically ill appears to provide a satisfactory clinical response, low relapse rate and no long-term complications in a well-defined group of patients. Multicentre studies are warranted to compare short versus long course therapy, and monotherapy versus combination therapy.
Keywords: fungaemia , intensive care unit , antibiotic therapy