Effect of an intensive care unit rotating empiric antibiotic schedule on the development of hospital-acquired infections on the non-intensive care unit ward

Michael G. Hughes, Heather L. Evans, Tae W. Chong, Robert L. Smith, Daniel P. Raymond, Shawn J. Pelletier, Timothy L. Pruett, Robert G. Sawyer

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Objective: We have previously shown that a rotating empirical antibiotic schedule could reduce infectious mortality in an intensive care unit (ICU). We hypothesized that this intervention would decrease infectious complications in the non-ICU ward to which these patients were transferred. Design: Prospective cohort study. Setting: An ICU and the ward to which the ICU patients were transferred at a university medical center. Patients: All patients treated on the general, transplant, or trauma surgery services who developed hospital-acquired infection while on the non-ICU wards. Interventions: A 2-yr study consisting of 1-yr non-protocol-driven antibiotic use and 1-yr quarterly rotating empirical antibiotic assignment for patients treated in the ICU from which a portion of the patients were transferred. Measurements and Main Results: There were 2,088 admissions to the non-ICU wards during the nonrotation year and 2,183 during the ICU rotation year. Of these patients, 407 hospital-acquired infections were treated during the nonrotation year and 213 were treated during the ICU rotation (19.7 vs. 9.8 infections/ 100 admissions, p < .0001). During the ICU rotation year a decrease in the rate of resistant Gram-positive and resistant Gram-negative infections on the non-ICU wards occurred (2.5 vs. 1.6 infections/100 admissions, p = .04; 1.0 vs. 0.4 infections/100 admissions, p = .03). Subgroup analysis revealed that the decrease in resistant infections on the wards was due to a reduction in resistant Gram-positive and resistant Gram-negative infections among non-ICU ward patients admitted initially from areas other than the ICU implementing the antibiotic rotation (e.g., home, other ward, or a different ICU) (1.8 vs. 0.5 infections/100 admissions, p = .0001; 0.7 vs. 0.2 infections/100 admissions, p = .02), not due to differences for those transferred to the ward from the rotation ICU (10.4 vs. 9.7 infections/100 admissions, p = 1.0; 4.3 vs. 1.9 infections/100 admissions, p = .3). No differences in infection-related mortality were detected. Conclusions: An effective rotating empirical antibiotic schedule in an ICU is associated with a reduction in infectious morbidity (hospital-acquired and resistant hospital-acquired infection rates) on the non-ICU wards to which patients are transferred.

Original languageEnglish (US)
Pages (from-to)53-60
Number of pages8
JournalCritical Care Medicine
Volume32
Issue number1
StatePublished - Jan 2004

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Cross Infection
Intensive Care Units
Appointments and Schedules
Anti-Bacterial Agents
Infection
Mortality
varespladib methyl
Cohort Studies
Prospective Studies
Morbidity
Transplants

Keywords

  • Antibiotic
  • Antibiotic rotation
  • Antimicrobial resistance
  • Hospital-acquired infection
  • Infection
  • Intensive care unit

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Hughes, M. G., Evans, H. L., Chong, T. W., Smith, R. L., Raymond, D. P., Pelletier, S. J., ... Sawyer, R. G. (2004). Effect of an intensive care unit rotating empiric antibiotic schedule on the development of hospital-acquired infections on the non-intensive care unit ward. Critical Care Medicine, 32(1), 53-60.

Effect of an intensive care unit rotating empiric antibiotic schedule on the development of hospital-acquired infections on the non-intensive care unit ward. / Hughes, Michael G.; Evans, Heather L.; Chong, Tae W.; Smith, Robert L.; Raymond, Daniel P.; Pelletier, Shawn J.; Pruett, Timothy L.; Sawyer, Robert G.

In: Critical Care Medicine, Vol. 32, No. 1, 01.2004, p. 53-60.

Research output: Contribution to journalArticle

Hughes, MG, Evans, HL, Chong, TW, Smith, RL, Raymond, DP, Pelletier, SJ, Pruett, TL & Sawyer, RG 2004, 'Effect of an intensive care unit rotating empiric antibiotic schedule on the development of hospital-acquired infections on the non-intensive care unit ward', Critical Care Medicine, vol. 32, no. 1, pp. 53-60.
Hughes, Michael G. ; Evans, Heather L. ; Chong, Tae W. ; Smith, Robert L. ; Raymond, Daniel P. ; Pelletier, Shawn J. ; Pruett, Timothy L. ; Sawyer, Robert G. / Effect of an intensive care unit rotating empiric antibiotic schedule on the development of hospital-acquired infections on the non-intensive care unit ward. In: Critical Care Medicine. 2004 ; Vol. 32, No. 1. pp. 53-60.
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AU - Raymond, Daniel P.

AU - Pelletier, Shawn J.

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N2 - Objective: We have previously shown that a rotating empirical antibiotic schedule could reduce infectious mortality in an intensive care unit (ICU). We hypothesized that this intervention would decrease infectious complications in the non-ICU ward to which these patients were transferred. Design: Prospective cohort study. Setting: An ICU and the ward to which the ICU patients were transferred at a university medical center. Patients: All patients treated on the general, transplant, or trauma surgery services who developed hospital-acquired infection while on the non-ICU wards. Interventions: A 2-yr study consisting of 1-yr non-protocol-driven antibiotic use and 1-yr quarterly rotating empirical antibiotic assignment for patients treated in the ICU from which a portion of the patients were transferred. Measurements and Main Results: There were 2,088 admissions to the non-ICU wards during the nonrotation year and 2,183 during the ICU rotation year. Of these patients, 407 hospital-acquired infections were treated during the nonrotation year and 213 were treated during the ICU rotation (19.7 vs. 9.8 infections/ 100 admissions, p < .0001). During the ICU rotation year a decrease in the rate of resistant Gram-positive and resistant Gram-negative infections on the non-ICU wards occurred (2.5 vs. 1.6 infections/100 admissions, p = .04; 1.0 vs. 0.4 infections/100 admissions, p = .03). Subgroup analysis revealed that the decrease in resistant infections on the wards was due to a reduction in resistant Gram-positive and resistant Gram-negative infections among non-ICU ward patients admitted initially from areas other than the ICU implementing the antibiotic rotation (e.g., home, other ward, or a different ICU) (1.8 vs. 0.5 infections/100 admissions, p = .0001; 0.7 vs. 0.2 infections/100 admissions, p = .02), not due to differences for those transferred to the ward from the rotation ICU (10.4 vs. 9.7 infections/100 admissions, p = 1.0; 4.3 vs. 1.9 infections/100 admissions, p = .3). No differences in infection-related mortality were detected. Conclusions: An effective rotating empirical antibiotic schedule in an ICU is associated with a reduction in infectious morbidity (hospital-acquired and resistant hospital-acquired infection rates) on the non-ICU wards to which patients are transferred.

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KW - Antibiotic

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