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

50 Scopus citations

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
DOIs
StatePublished - Jan 2004

Keywords

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

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Effect of an intensive care unit rotating empiric antibiotic schedule on the development of hospital-acquired infections on the non-intensive care unit ward'. Together they form a unique fingerprint.

  • Cite this