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JAC Advance Access published online on September 16, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh416
© 2004 by The British Society for Antimicrobial Chemotherapy
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Received January 16, 2004
Revised May 25, 2004
Accepted July 22, 2004

Original article

Prospective audit of bacteraemia management in a university hospital ICU using a general strategy of short-course monotherapy

Alberto Corona 1*, A. Peter R. Wilson 2, Mario Grassi 3, and Mervyn Singer 1

1 Bloomsbury Institute of Intensive Care Medicine, University College London, Jules Thorn Building, Middlesex Hospital, Mortimer Street, London W1N 3AA, UK
2 Department of Clinical Microbiology, University College London Hospitals, London, UK
3 Dipartimento di Scienze Sanitarie Applicate, Università di Pavia, Pavia, Italy

* To whom correspondence should be addressed. E-mail: corona.alberto{at}libero.it.


  Abstract

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.
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