Duration of Antimicrobial Treatment for Bacteremia in Canadian Critically Ill Patients*

February 5, 2016 at 8:11 am

Critical Care Medicine February 2016  V.44 N.2 P.256-264

Daneman, Nick MD1; Rishu, Asgar H. MBBS2; Xiong, Wei MSc2; Bagshaw, Sean M. MD3; Dodek, Peter MD4; Hall, Richard MD5; Kumar, Anand MD6; Lamontagne, Francois MD7; Lauzier, Francois MD8; Marshall, John MD9; Martin, Claudio M. MD10; McIntyre, Lauralyn MD11; Muscedere, John MD12; Reynolds, Steve MD13; Stelfox, Henry T. MD14; Cook, Deborah J. MD15; Fowler, Robert A. MD16; on behalf of the Canadian Critical Care Trials Group

1Division of Infectious Diseases, Department of Medicine and Clinical Epidemiology, Sunnybrook Health Sciences Centre, University of Toronto and Adjunct Scientist, Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.

2Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.

3Division of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada.

4Division of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St. Paul’s Hospital and University of British Columbia, Vancouver, BC, Canada.

5Department of Critical Care Medicine, Dalhousie University and the Capital District, Health Authority, Halifax, NS, Canada.

6Sections of Critical Care Medicine and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada.

7Department of Medicine, Centre de recherche du CHU de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada.

8Centre de recherche du CHU de Québec, Axe santé des populations et pratiques optimales en santé, Division de soins intensifs adultes, départements de médecine et d’anesthésiologie, Université Laval, Quebec, QC, Canada.

9Departments of Surgery and Critical Care Medicine, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada.

10Department of Medicine, University of Western Ontario, London, ON, Canada.

11Division of Critical Care, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada.

12Department of Medicine, Queen’s University, Kingston, ON, Canada.

13Department of Medicine, University of British Columbia, Vancouver, BC, Canada.

14Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.

15Departments of Medicine, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.

16Department of Medicine and Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.

Objectives

The optimum duration of antimicrobial treatment for patients with bacteremia is unknown. Our objectives were to determine duration of antimicrobial treatment provided to patients who have bacteremia in ICUs, to assess pathogen/patient factors related to treatment duration, and to assess the relationship between treatment duration and survival.

Design

Retrospective cohort study.

Settings

Fourteen ICUs across Canada.

Patients

Patients with bacteremia and were present in the ICU at the time culture reported positive.

Interventions

Duration of antimicrobial treatment for patients who had bacteremia in ICU.

Measurements and Main Results

Among 1,202 ICU patients with bacteremia, the median duration of treatment was 14 days, but with wide variability (interquartile range, 9–17.5). Most patient characteristics were not associated with treatment duration. Coagulase-negative staphylococci were the only pathogens associated with shorter treatment (odds ratio, 2.82; 95% CI, 1.51–5.26). The urinary tract was the only source of infection associated with a trend toward lower likelihood of shorter treatment (odds ratio, 0.67; 95% CI, 0.42–1.08); an unknown source of infection was associated with a greater likelihood of shorter treatment (odds ratio, 2.14; 95% CI, 1.17–3.91). The association of treatment duration and survival was unstable when analyzed based on timing of death.

Conclusions

Critically ill patients who have bacteremia typically receive long courses of antimicrobials. Most patient/pathogen characteristics are not associated with treatment duration; survivor bias precludes a valid assessment of the association between treatment duration and survival. A definitive randomized controlled trial is needed to compare shorter versus longer antimicrobial treatment in patients who have bacteremia.

FULL TEXT

http://journals.lww.com/ccmjournal/Fulltext/2016/02000/Duration_of_Antimicrobial_Treatment_for_Bacteremia.3.aspx

PDF (DOWNLOAD CLIC IN PDF)

 

Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, F.O.D, Health Care-Associated Infections, Infecciones nosocomiales, Infecciones urinarias, Metodos diagnosticos, Resistencia bacteriana, Sepsis, Update. Tags: .

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2016 Association between Regimen Composition and Treatment Response in Patients with Multidrug-Resistant Tuberculosis: A Prospective Cohort Study


Calendar

February 2016
M T W T F S S
« Jan   Mar »
1234567
891011121314
15161718192021
22232425262728
29  

Most Recent Posts


%d bloggers like this: