Medical microbiology ward rounds in critical care

Background

Direct microbiological input to critical care is essential for the management of the septic patient. Early broad-spectrum antimicrobial therapy with appropriate diagnostic studies to ascertain causative organisms is well established; there should be reassessment with the aim of using narrow-spectrum antibiotics to prevent the development of antimicrobial resistance, to reduce toxicity and to reduce costs [1]. In systematic analysis of ward rounds in ICUs the information most commonly missing from a patient's file concerned microbiology findings [2].

Methods

We performed a telephone survey of all NHS critical care units in the North West of England (n = 31). Each unit was telephoned and the duty consultant was asked a series of questions relating to the type of microbiology input to their critical care unit.

Results

We achieved a 100% response rate. The study looked at 11 teaching hospitals and 21 district general hospitals representing 12% of UK ICUs: 26 (83%) critical care units had live computerised access to microbiology data, 21 (68%) units had an antibiotic policy in place, and 19 (61%) units had a formal microbiology ward round. With the frequency ranging from once per week (one unit) to 7 days per week (four units), most units with a microbiology ward round had this service Monday–Friday (12 units). When asked to rate the value of this ward round, the mean score was 8.6 out of a possible 10 (range 10–5, mode 9). In those units without a microbiology ward round the desirability of such a service was scored on average at 8.5 out of 10 (range 10–3, mode 9).

Conclusion

Direct microbiological advice at the bedside is highly valued by ICU consultants. Antibiotic prescribing is generally well controlled, with two-thirds of units having an agreed antibiotic policy in place. Work will continue to determine whether these results reflect the national picture in the United Kingdom.