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Optimizing Empirical Antimicrobial Therapy for Infection due to Gram-Negative Pathogens in the Intensive Care Unit: Utility of a Combination Antibiogram

Published online by Cambridge University Press:  02 January 2015

Jennifer Christoff ,
Jocelyn Tolentino ,
Emily Mawdsley ,
Scott Matushek ,
David Pitrak  and
Stephen G. Weber
Jennifer Christoff*
Affiliation:
Section of Infectious Diseases, University of Chicago Medical Center, Chicago, Illinois
Jocelyn Tolentino
Affiliation:
Section of Infectious Diseases, University of Chicago Medical Center, Chicago, Illinois Infection Control Program, University of Chicago Medical Center, Chicago, Illinois
Emily Mawdsley
Affiliation:
Section of Infectious Diseases, University of Chicago Medical Center, Chicago, Illinois
Scott Matushek
Affiliation:
Clinical Microbiology Laboratory, University of Chicago Medical Center, Chicago, Illinois
David Pitrak
Affiliation:
Section of Infectious Diseases, University of Chicago Medical Center, Chicago, Illinois
Stephen G. Weber
Affiliation:
Section of Infectious Diseases, University of Chicago Medical Center, Chicago, Illinois Infection Control Program, University of Chicago Medical Center, Chicago, Illinois
*
University of Chicago Medical Center, 5841 S Maryland Ave (MC 5065), Chicago, IL 60637 ([email protected])
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Extract

Objective.

To determine whether the use of dual antimicrobial therapy based on the results of a combination antibiotic susceptibility report (antibiogram) increases the likelihood of selecting adequate empirical coverage in critically ill patients with infection due to potentially resistant gram-negative pathogens.

Design.

Retrospective data analysis.

Setting.

Urban academic medical center.

Methods.

An analysis of culture results and susceptibility data from intensive care unit patients determined by the clinical microbiology laboratory was performed. The proportion of 5 common gram-negative pathogens susceptible to monotherapy with 1 of 3 antipseudomonal antibiotics (piperacillin-tazobactam, ceftazidime, or imipenem) was compared with the proportion susceptible to each of these 3 “backbone” agents plus 1 of 4 additional antimicrobial agents used in combination.

Results.

More than 5,000 clinical isolates were examined. When all isolates recovered during the entire study period were included, the addition of any of the second antibiotics studied to each of the 3 backbone agents significantly increased the likelihood of covering the causative pathogen (P<.01 for each). The benefit of combination therapy was variable when results for each of the 5 organisms were examined individually. When temporal trends in susceptibility were examined, the decrease in the proportion of organisms susceptible to monotherapy was statistically significant for both imipenem and ceftazidime (P<.01).

Conclusions.

Reporting antibiotic susceptibility data in the form of a combination antibiogram may be useful to clinicians who are considering empirical antimicrobial therapy in the intensive care unit.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 3 , March 2010 , pp. 256 - 261
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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