Patient-to-patient antibiotic rotation

Objective

To evaluate ICU-acquired infections, germs responsible and sensibility to antibiotics in an ICU using a patient-to-patient antibiotic rotation. We have compared our dates with EPIC study.

Methods

It is a prospective study in a 20-bed medical-surgical intensive care unit. Included were all patients admitted in ICU during 19 months in two periods of time (first period from 1 January 1999 to 30 July 1999, second period from 1 May 2000 to 30 April 2001), with a length of stay in ICU longer than 24 hours. The infections were diagnosed according to CDC criteria.

Results

Studied were 978 patients (371 and 607 patients in respective periods of time), 601 males and 377 females. Mean age was 57.01 ± 17.80 years. APACHE-II was 13.76 ± 6.31. Mortality was 14.21%. Patients distribution was: 46% cardiac surgery, 11% cardiologic, 10% neurologic, 10% traumathology, 8% pulmonary, 5% digestive, 10% others. We diagnosed 315 UCI-acquired infections in 182 patients. Distribution infections was: respiratory 39%, urinary tract infection 28%, central venous catheter 12%, primary bloodstream 12%, wound surgical 5%, nervous central system 4%. We isolated 322 germs: 47% Gram negative, 43% Gram positive, 10% fungi. We found the following differences between EPIC and our data: (a) rate infections for Pseudomonas aeruginosa 28–7.1%, for acinetobacter 9–0.3%, for fungi 17–9.9%; (b) rate resistance of pseudomonas to gentamicin 46–25%, to ureidopenicillin 37–14%, to ceftazidime 27–18%, to ciprofloxacin 26–5%, to imipenem 21–13%; (c) rate resistance of Staphylococci aureus to methicillin 60–17%; (d) rate resistance of coagulase-negative staphylococci to vancomycin 3–0%.

Conclusions

In our ICU, with a patient-to-patient antibiotic rotation, we had no serious problems of resistance to antibiotics.