Gary Duclos1, Bruno Pastene1, Fanny Depeyre1, Zoé Meresse1, Nadim Cassir2, Ignacio Martin-Loeches3, Sharon Einav4, Laurent Zieleskiewicz1, Marc Leone1. 1. Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Aix Marseille Université, Marseille, France. 2. Unité de Recherche sur les Maladie Infectieuses et Tropicales Émergentes, Aix Marseille Université, Marseille, France. 3. Multidisciplinary Intensive Care, St James's University Hospital and Department of Clinical Medicine, Trinity College, Dublin, Ireland. 4. General Intensive Care Unit, Shaare Zedek Medical Centre, Hebrew University Faculty of Medicine, Jerusalem, Israel.
Abstract
BACKGROUND: Surgical antimicrobial prophylaxis (SAP) is supported by evidence-based guidelines. Nevertheless, SAP guidelines do not cover all clinical scenarios. To our knowledge, no information is available regarding SAP in the critically ill patients. We designed a retrospective, observational and preliminary study which the objective was to describe our professional practices in intensive care unit (ICU) patients requiring SAP. METHODS: All patients admitted for more than 48 h in the ICU and requiring surgery were retrospectively included from January 1st to December 31, 2016. We collected data related to infection, colonization and antimicrobial treatments pre- and post-operatively. We assessed the compliance of SAP to guidelines. RESULTS: Among 41 included patients, 13 (32%) were treated for an ongoing infection and 21 (51%) received at least one antibiotic during the ICU stay. Seven (17%) were colonized. Twenty-one (51%) patients received SAP according to guidelines. Thirteen postoperative infections including 1 surgical site infection were reported. For 10 (24%) patients, the ongoing antimicrobial treatment was continued in the operating room. No surgical site infection and 1 lung infection was reported. In 3 (7%) patients, no SAP was administered and 1 episode of bacteremia was noted. Three (7%) patients had their ongoing treatment changed in the operating room. Two of them developed a lung infection. The other patients were assessed individually due to complex conditions. CONCLUSIONS: These preliminary data showed a large heterogeneity in the management of SAP in the ICU, suggesting the need for specific guidelines based on clinical trials.
BACKGROUND: Surgical antimicrobial prophylaxis (SAP) is supported by evidence-based guidelines. Nevertheless, SAP guidelines do not cover all clinical scenarios. To our knowledge, no information is available regarding SAP in the critically ill patients. We designed a retrospective, observational and preliminary study which the objective was to describe our professional practices in intensive care unit (ICU) patients requiring SAP. METHODS: All patients admitted for more than 48 h in the ICU and requiring surgery were retrospectively included from January 1st to December 31, 2016. We collected data related to infection, colonization and antimicrobial treatments pre- and post-operatively. We assessed the compliance of SAP to guidelines. RESULTS: Among 41 included patients, 13 (32%) were treated for an ongoing infection and 21 (51%) received at least one antibiotic during the ICU stay. Seven (17%) were colonized. Twenty-one (51%) patients received SAP according to guidelines. Thirteen postoperative infections including 1 surgical site infection were reported. For 10 (24%) patients, the ongoing antimicrobial treatment was continued in the operating room. No surgical site infection and 1 lung infection was reported. In 3 (7%) patients, no SAP was administered and 1 episode of bacteremia was noted. Three (7%) patients had their ongoing treatment changed in the operating room. Two of them developed a lung infection. The other patients were assessed individually due to complex conditions. CONCLUSIONS: These preliminary data showed a large heterogeneity in the management of SAP in the ICU, suggesting the need for specific guidelines based on clinical trials.
Entities:
Keywords:
Surgical antimicrobial prophylaxis (SAP); intensive care unit (ICU); microbiology
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