ICU-acquired infections on a patient-to-patient antibiotic rotation policy in ICU

Objective

To determine ICU-acquired infections and sensibility to antibiotics by an antibiotic therapy policy with a patient-to-patient rotation. We have compared our dates with EPIC study [1].

Design

Prospective observational study.

Setting

A 20-bed medical-surgical Intensive Care Unit (ICU).

Patients

All patients admitted in ICU from 1-1-1999 to 30-7-1999 and from 16-6-2000 to 16-10-2000, with a length of stay in ICU longer than 24 hours. The infections were diagnosed according to the criteria of the CDC.

Results

371 patients (66.85% males) and 163 patients (63.19% males) fulfilled all criteria in respectives periods. Mean age was 57.71 ± 16.85 years and 57.58 ± 16.56 years. APACHE-II was 14.4 ± 6.2 and 12.5 ± 5.2. Mortality was 12.18% and 12.19%. Patients distribution was: 43% and 46% cardiac surgery, 14% and 15% cardiologic, 9% and 13% neurologic, 9% and 7% traumathology, 10% and 5% pulmonary, 5% and 6% digestive, 10% and 8% others. Mechanical ventilation was need in 74% and 91%, central venous line in 79% and 97%, vesical catheter in 92% and 97%. We diagnosed 145 UCI-acquired infections in 90 patients and 105 UCI-acquired infections in 52 patients. Distribution infections was: respiratory 40% and 39%, urinary tract 28% and 22%, bloodstream 14% and 12%, others 18% and 27%; 152 and 106 germs were isolated: 48% and 45% gram negative, 45% and 45% gram positive, 7% and 10% fungi. Most frequently germs reported in first period were: 15% S. Aureus, 12% Enterococci and 11% E. Coli; and second period were: 19% Epidermidis Staphylococci, 9% S. Aureus and 9% E. coli. The differences we found with EPIC are shown in the Table.

Table Table

Conclusions

The antibiotic therapy policy with a patient-to-patient rotation can be useful for the control of infectious mape in ICU.