, Volume 22, Issue 5, pp 387-394

Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit

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Abstract

Objective

To assess the frequency of and the reasons for changing empiric antibiotics during the treatment of pnnumonia acquired in the intensive care unit (ICU).

Design

A prospective multicenter study of 1 year's duration.

Setting

Medical and surgical ICUs in 30 hospitals all over Spain.

Patients

Of a total of 16872 patients initially enrolled into the study, 530 patients developed 565 episodes of pneumonia after admission to the ICU.

Results

Empiric antibiotics were administered in 490 (86.7%) of the 565 episodes of pneumonia. The antimicrobials most frequently used were amikacin in 120 case, tobramycin in 110, ceftazidime in 96, and cefotaxime in 96. Monotherapy was indicated in 135 (27.6%) of the 490 episodes, a combination of two antibiotics in 306 episodes (62.4%), and a combination of three antibiotics in 49 episodes (10%). The empiric antibiotic treatment was modified in 214 (43.7%) cases because of isolation of a microorganism not covered by treatment in 133 (62.1%) cases, lack of clinical response in 77 (36%), and development of resistance in 14 (6.6%). Individual factors associated with modification of empiric treatment identified in the multivariate analysis were microorganism not covered (relative risk (RR)) 22.02; 95% confidence interval (CI) 11.54 to 42.60;p<0.0001), administration of more than one antimicrobial (RR 1.29; 95% CI 1.02 to 1.65;p=0.0018) attributable mortability was 16.2%.

Supported by a grant from Bristol-Myers-Squibb. The results of this study were presented in part at the 4th Panamerican and Iberic Congress on Intensive Care, Rio de Janeiro, Brazil, 1991