Jonathan D Edgeworth1, Irina Chis Ster2, Duncan Wyncoll3, Manu Shankar-Hari3, Catherine A McKenzie4. 1. Centre for Clinical Infection and Diagnostic Research (CIDR), Department of Infectious Diseases, Kings College London and Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK jonathan.edgeworth@gstt.nhs.uk. 2. Centre for Clinical Infection and Diagnostic Research (CIDR), Department of Infectious Diseases, Kings College London and Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK. 3. School of Medicine, Kings College London and Critical Care, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK. 4. Institute of Pharmaceutical Sciences, Franklin Wilkins Building, Kings College, London SE1 7RT, UK Department of Pharmacy, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
Abstract
OBJECTIVES: To determine long-term adherence to a 5 day antibiotic course guideline for treating intensive care unit (ICU)-acquired Gram-negative bacteria (GNB) infections. METHODS: Descriptive analysis of patient-level data on all GNB-active antibiotics prescribed from day 3 and all GNB identified in clinical samples in 5350 patients admitted to a 30 bed general ICU between 2002 and 2009. RESULTS: Four thousand five hundred and eleven of 5350 (84%) patients were treated with one or more antibiotics active against GNB commenced from day 3. Gentamicin was the most frequently prescribed antibiotic (92.2 days of therapy/1000 patient-days). Only 6% of courses spanned >6 days of therapy and 89% of antibiotic therapy days were with a single antibiotic active against GNB. There was no significant difference between gentamicin and meropenem in the number of first courses in which a resistant GNB was identified in blood cultures [11/1177 (0.9%) versus 5/351 (1.4%); P = 0.43] or respiratory tract specimens [59/951 (6.2%) versus 17/246 (6.9%); P = 0.68] at the time of starting therapy. CONCLUSIONS: This study demonstrates long-term adherence to a 5 day course antibiotic guideline for treatment of ICU-associated GNB infections. This guideline is a potential antibiotic-sparing alternative to currently recommended dual empirical courses extending to ≥7 days.
OBJECTIVES: To determine long-term adherence to a 5 day antibiotic course guideline for treating intensive care unit (ICU)-acquired Gram-negative bacteria (GNB) infections. METHODS: Descriptive analysis of patient-level data on all GNB-active antibiotics prescribed from day 3 and all GNB identified in clinical samples in 5350 patients admitted to a 30 bed general ICU between 2002 and 2009. RESULTS: Four thousand five hundred and eleven of 5350 (84%) patients were treated with one or more antibiotics active against GNB commenced from day 3. Gentamicin was the most frequently prescribed antibiotic (92.2 days of therapy/1000 patient-days). Only 6% of courses spanned >6 days of therapy and 89% of antibiotic therapy days were with a single antibiotic active against GNB. There was no significant difference between gentamicin and meropenem in the number of first courses in which a resistant GNB was identified in blood cultures [11/1177 (0.9%) versus 5/351 (1.4%); P = 0.43] or respiratory tract specimens [59/951 (6.2%) versus 17/246 (6.9%); P = 0.68] at the time of starting therapy. CONCLUSIONS: This study demonstrates long-term adherence to a 5 day course antibiotic guideline for treatment of ICU-associated GNB infections. This guideline is a potential antibiotic-sparing alternative to currently recommended dual empirical courses extending to ≥7 days.
Authors: Nick Culshaw; Guy Glover; Craig Whiteley; Katie Rowland; Duncan Wyncoll; Andrew Jones; Manu Shankar-Hari Journal: Ann Intensive Care Date: 2014-11-25 Impact factor: 6.925
Authors: Themoula Charalampous; Adela Alcolea-Medina; Luke B Snell; Tom G S Williams; Rahul Batra; Christopher Alder; Andrea Telatin; Luigi Camporota; Christopher I S Meadows; Duncan Wyncoll; Nicholas A Barrett; Carolyn J Hemsley; Lisa Bryan; William Newsholme; Sara E Boyd; Anna Green; Ula Mahadeva; Amita Patel; Penelope R Cliff; Andrew J Page; Justin O'Grady; Jonathan D Edgeworth Journal: Genome Med Date: 2021-11-17 Impact factor: 11.117