JAC Advance Access originally published online on September 30, 2003
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Journal of Antimicrobial Chemotherapy (2003) 52, 849-852
© 2003 The British Society for Antimicrobial Chemotherapy
Variability of treatment duration for bacteraemia in the critically ill: a multinational survey
1 Laboratory of Clinical Epidemiology, GiViTI Coordinating Centre, Istituto di Ricerche Farmacologiche Mario Negri, Centro di Ricerche Cliniche per le Malattie Rare Aldo e Cele Daccò, Ranica (BG), Italy; 2 Department of Microbiology, University College London Hospitals NHS Trust, London; 3 Bloomsbury Institute of Intensive Care Medicine, Department of Medicine, University College London, 5th Floor, Jules Thorn Building, Middlesex Hospital, Mortimer St, London W1T 3AA, UK
Received 1 May 2003; returned 18 July 2003; revised 14 August 2003; accepted 17 August 2003
Objectives: No definitive evidence is available to inform ‘best’ antibiotic practice for treating bacteraemia in the critically ill patient, either in terms of duration of therapy, or the use of mono- versus combination therapy. We therefore undertook a large-scale international survey to assess the variability of current practice.
Methods: A questionnaire was sent to membership lists of national and international intensive care societies.
Results: Responses from 254 intensive care units in 34 countries revealed a wide variation in antibiotic strategy for all types of bacteraemia, ranging from short course (
5 days) therapy with restricted-spectrum antibiotics, to long course (
10 days) use of broad-spectrum combinations. Two factors were significantly associated with antibiotic prescribing practice, namely the country of origin (in those with 10 responders) and the level of microbiologist and/or infectious diseases specialist input. The greater the specialist input, the shorter the duration of therapy (P < 0.0001).
Conclusions: The wide variability in antibiotic prescribing patterns suggests an urgent need to produce high-quality evidence to identify optimal antibiotic prescribing policies for bacteraemia in the critically ill patient.
Keywords: intensive care, antibiotics, sepsis, infections
* Corresponding author. Tel: +44-20-7679-9666; Fax: +44-20-7679-9660; E-mail: m.singer{at}ucl.ac.uk
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