The ACCP contact for the news release is Kimberly Lynch who can be reached at (847) 498-8341 or [email protected].
For release: July 13, 2000
INADEQUATE ANTIMICROBIAL TREATMENT OF BLOODSTREAM INFECTIONS LEADS TO SIGNIFICANT MORTALITY RATE IN INTENSIVE CARE UNITS
A two-year study conducted at an urban teaching hospital's medical and surgical intensive care units showed that 147 persons (almost 30 percent) of 492 critically ill patients who had a bloodstream infection received inadequate antimicrobial therapy, with 91 of those individuals (about 62 percent) dying. This research, according to the authors, demonstrated a significant direct association between the administration of inadequate antimicrobial treatment for pathogens and associated rates of hospital mortality.
During the July 1997 to July 1999 study at Barnes Jewish Hospital's intensive care units in St. Louis, Missouri, the death rate for the 345 critically ill patients with bloodstream infections who received adequate antimicrobial therapy was slightly over 28 percent.
Writing in the July issue of CHEST, the monthly peer-reviewed journal of the American College of Chest Physicians, Marin H. Kollef, M.D., FCCP, Pulmonary and Critical Care Division, Washington University School of Medicine, St. Louis, Missouri, along with four colleagues, said that their data suggest efforts should be made to reduce the administration of inadequate antimicrobial treatment to hospitalized patients with bloodstream infections, especially in those infected with antibiotic-resistant bacteria and Candida species. Candida is a yeastlike fungus that only rarely invades the bloodstream.
Of the 492 patients studied, 193 (slightly over 39 percent) had a community-acquired bloodstream infection, 291 (slightly over 59 percent) had hospital-acquired bacteremia or presence of bacteria in the blood, and 8 patients had a community-acquired infection first followed by a hospital-acquired one. "Patients with a hospital-acquired bloodstream infection were statistically more likely to receive inadquate antimicrobial treatment compared to patients with a community-acquired bloodstream infection," said Dr. Kollef.
According to the authors, the risk factors for the administration of inadequate antibiotic treatment appeared to share common characteristics: the presence of an antibiotic-resistant pathogen such as a Candida species, or having had therapy predisposing to the development of an antibiotic-resistant infection, such as either prior antibiotic treatment or prolonged central vein catheterization.
Dr. Kollef noted that predicting the presence of an antibiotic-resistant bloodstream infection can be difficult. However, he said that prior antibiotic exposure, prolonged hospitalization, and the presence of invasive devices have all been associated with its occurrence.
The article notes the staggering overall national costs of antimicrobial resistance, with some estimates ranging as high as $30 billion annually for the control and treatment of such infections.
To balance the competing issues of providing adequate antimicrobial treatment to potentially infected patients against the risk of unnecessary antibiotic treatment , the researchers suggest the early administration of broad spectrum antimicrobial treatment to high-risk patients with suspected bloodstream infections. This approach should be followed by the rapid tailoring of the antimicrobial regimen, or its discontinuance, based on culture results and the patient's clinical course.
CHEST is published by the American College of Chest Physicians, which represents 15,000 members who provide clinical, respiratory, and cardiothoracic patient care in the U.S. and throughout the world.
Reporters may wish to contact Kimberly Lynch of the ACCP at (847) 498-8341 for a copy of the article. She can also be reached by fax at (847) 498-5460 or by email at [email protected]. Dr. Kollef can be reached by phone at (314) 454-8764 or by fax at (314) 454-5571. He can also be reached by email at [email protected].
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