Incidence and Susceptibility of Pathogenic Bacteria Vary between Intensive Care Units within a Single Hospital: Implications for Empiric Antibiotic Strategies

Namias, Nicholas; Samiian, Laila; Niño, Diego F.; Shirazi, Ehsan; O’neill, Kirsten; Kett, Daniel H.; Ginzburg, Enrique; McKenney, Mark; Sleeman, Danny; Cohn, Stephen M.

doi:10.1097/00005373-200010000-00010

Cited by 103 publications

(66 citation statements)

References 15 publications

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“…They suggested the possibility that, in large hospitals, the etiology of ventilator-associated pneumonia may var y significantly between ICUs, which we found to be true. Namias et al 15 found significant variability in antibiotic susceptibility between ICUs in a large teaching hospital. However, their study was confined to one hospital during a short (3-month) time period.…”

Section: Discussionmentioning

confidence: 98%

“…The organisms associated with ventilator-associated pneumonia that we identified are similar to those reported in the literature. 12,13,15,16,18 The most common causes overall are P. aeruginosa and Staphylococcus aureus. Early cases of ventilator-associated pneumonia are more commonly associated with methicillin-sensitive Staphylococcus aureus and late cases with methicillin-resistant Staphylococcus aureus.…”

Section: Discussionmentioning

confidence: 99%

“…14 Several studies have recommended that antibiotic choices be guided by knowledge of the common etiologic agents for ventilator-associated pneumonia in individual hospitals. [13][14][15][16] There may be significant differences in the microbiologic etiologies of pneumonia in different hospitals and in different intensive care units (ICUs) within a single hospital. Little data exist about ventilator-associated pneumonia in pediatric settings.…”

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confidence: 99%

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Ventilator-Associated Pneumonia in a Multi-Hospital System Differences in Microbiology by Location

Babcock

Zack

Garrison

et al. 2003

Infect. Control Hosp. Epidemiol.

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Objective:To determine whether there were differences in the microbiologic etiologies of ventilator-associated pneumonia in different clinical settings.Design:Observational retrospective cohort study of microbiologic etiologies of ventilator-associated pneumonia from 1998 to 2001 in a multi-hospital system. Microbiologic results were compared between hospitals and between different intensive care units (ICUs) within hospitals.Setting:Three hospitals—one pediatric teaching hospital, one adult teaching hospital, and one community hospital— in one healthcare system in the midwestern United States.Patients:Patients at the target hospitals who developed ventilator-associated pneumonia and for whom microbiologic data were available.Results:Seven hundred fifty-three episodes of ventilator-associated pneumonia had culture data available for review. The most common organisms at all hospitals were Staphylococcus aureus (28.4%) and Pseudomonas aeruginosa (25.2%). The pediatric hospital had higher proportions of Escherichia coli (9.5% vs 2.3%; P < .001) and Klebsiella pneumoniae (13% vs 3.1%; P < .001) than did the adult hospitals. In the pediatric hospital, the pediatric ICU had higher P. aeruginosa rates than did the neonatal ICU (33.3% vs 17%; P = .01). In the adult hospitals, the surgical ICU had higher Acinetobacter baumannii rates (10.2% vs. 1.7%; P < .001) than did the other ICUs.Conclusions:Microbiologic etiologies of ventilator-associated pneumonia vary between and within hospitals. Knowledge of these differences can improve selection of initial antimicrobial regimens, which may decrease mortality.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Ventilator-Associated Pneumonia in a Multi-Hospital System Differences in Microbiology by Location

Babcock

Zack

Garrison

et al. 2003

Infect. Control Hosp. Epidemiol.

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“…This would facilitate the selection and administration of appropriate empirical systemic antimicrobial agents prior to the availability of microbiological culture and susceptibility test results. It is recognized that the antimicrobial susceptibility profiles of the burn unit microbial flora may not necessarily correlate with identical pathogens recovered from other units in the same hospital, and hence, the general hospital antibiogram cannot be relied upon for guiding empirical antimicrobial therapeutic decisions in burn unit patients (124,313). Liaison between plastic surgeons, infectious disease physicians, and clinical microbiologists is essential to facilitate the development of burn unit-specific empirical treatment algorithms based on an updated yearly antibiogram data and outcome analyses.…”

Section: Antimicrobial Susceptibility Testingmentioning

confidence: 99%

“…Prescription is also based on the individual preparation of the topical agent (e.g., ointment or cream versus solution or dressing) and its pharmacokinetic properties. Burn units may rotate the use of various topical antimicrobial preparations on a regular basis to decrease the potential for development of antibiotic resistance (6,124,313). Topical antibiotic agents should first be applied directly to the patient's dressings before application to the burn wound to prevent contamination of the agent's container by burn wound flora.…”

Section: Topical Antimicrobial Therapymentioning

confidence: 99%

Burn Wound Infections

Church

Elsayed

Reid³

et al. 2006

Clin Microbiol Rev

1,620

1,345

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SUMMARYBurns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices.

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Empiric antibiotic selection strategies for healthcare‐associated pneumonia, intra‐abdominal infections, and catheter‐associated bacteremia

Snydman

2012

Journal of Hospital Medicine

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Initial selection and early deployment of appropriate/adequate empiric antimicrobial therapy is critical to minimize the significant morbidity and mortality associated with hospital‐ or healthcare‐associated infections (HAIs). Initial empiric therapy that inadequately covers the pathogen(s) causing a serious HAI has been associated with increased mortality, longer hospital stay, and elevated healthcare costs. Moreover, subsequent modification of initial inadequate therapy, later in the disease process when culture results become available, may not remedy the impact of the initial choice. Because of this, it is important that initial empiric therapy covers the most likely pathogens associated with infection in a particular patient, even if this initial regimen turns out to be unnecessarily broad, based on subsequent culture results. The current paradigm for management of serious HAIs is to initiate empiric therapy with a broad‐spectrum regimen covering likely pathogens, based on local surveillance and susceptibility data, and presence of risk factors for involvement of a resistant microorganism. Subsequent modification (de‐escalation) of the initial regimen becomes possible later, when culture results are available and clinical status can be better assessed, 2 to 4 days after initiation of empiric therapy. When possible, de‐escalation and other steps to modify antimicrobial exposure are important for minimizing risk of antimicrobial resistance development. This article examines the general process for selection of initial empiric antibiotic therapy for patients with HAIs, illustrated through 3 case studies dealing with healthcare‐associated pneumonia, complicated intra‐abdominal infection, and catheter‐associated bacteremia, respectively. Journal of Hospital Medicine 2012;7:S2–S12. © 2012 Society of Hospital Medicine

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Incidence and Susceptibility of Pathogenic Bacteria Vary between Intensive Care Units within a Single Hospital: Implications for Empiric Antibiotic Strategies

Cited by 103 publications

References 15 publications

Ventilator-Associated Pneumonia in a Multi-Hospital System Differences in Microbiology by Location

Ventilator-Associated Pneumonia in a Multi-Hospital System Differences in Microbiology by Location

Burn Wound Infections

Empiric antibiotic selection strategies for healthcare‐associated pneumonia, intra‐abdominal infections, and catheter‐associated bacteremia

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