Abstract
Objective: We have previously shown that a rotating empirical antibiotic schedule could reduce infectious mortality in an intensive care unit (ICU). We hypothesized that this intervention would decrease infectious complications in the non-ICU ward to which these patients were transferred. Design: Prospective cohort study. Setting: An ICU and the ward to which the ICU patients were transferred at a university medical center. Patients: All patients treated on the general, transplant, or trauma surgery services who developed hospital-acquired infection while on the non-ICU wards. Interventions: A 2-yr study consisting of 1-yr non-protocol-driven antibiotic use and 1-yr quarterly rotating empirical antibiotic assignment for patients treated in the ICU from which a portion of the patients were transferred. Measurements and Main Results: There were 2,088 admissions to the non-ICU wards during the nonrotation year and 2,183 during the ICU rotation year. Of these patients, 407 hospital-acquired infections were treated during the nonrotation year and 213 were treated during the ICU rotation (19.7 vs. 9.8 infections/ 100 admissions, p < .0001). During the ICU rotation year a decrease in the rate of resistant Gram-positive and resistant Gram-negative infections on the non-ICU wards occurred (2.5 vs. 1.6 infections/100 admissions, p = .04; 1.0 vs. 0.4 infections/100 admissions, p = .03). Subgroup analysis revealed that the decrease in resistant infections on the wards was due to a reduction in resistant Gram-positive and resistant Gram-negative infections among non-ICU ward patients admitted initially from areas other than the ICU implementing the antibiotic rotation (e.g., home, other ward, or a different ICU) (1.8 vs. 0.5 infections/100 admissions, p = .0001; 0.7 vs. 0.2 infections/100 admissions, p = .02), not due to differences for those transferred to the ward from the rotation ICU (10.4 vs. 9.7 infections/100 admissions, p = 1.0; 4.3 vs. 1.9 infections/100 admissions, p = .3). No differences in infection-related mortality were detected. Conclusions: An effective rotating empirical antibiotic schedule in an ICU is associated with a reduction in infectious morbidity (hospital-acquired and resistant hospital-acquired infection rates) on the non-ICU wards to which patients are transferred.
Original language | English (US) |
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Pages (from-to) | 53-60 |
Number of pages | 8 |
Journal | Critical care medicine |
Volume | 32 |
Issue number | 1 |
DOIs | |
State | Published - Jan 2004 |
Keywords
- Antibiotic
- Antibiotic rotation
- Antimicrobial resistance
- Hospital-acquired infection
- Infection
- Intensive care unit
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine