Effect of an antibiotic algorithm on the adequacy of empiric antibiotic therapy given by a medical emergency team
Abstract Introduction Delayed administration of effective antimicrobial therapy increases mortality in patients with septic shock. Empiric antibiotic selection in this setting can be inaccurate. The objective of this study was to determine whether an antibiotic algorithm (AA) tailored to institution...
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| Veröffentlicht in: | Journal of critical care 2012-02, Vol.27 (1), p.45-50 |
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| creator | Miano, Todd A., PharmD Powell, Elizabeth, MD Schweickert, William D., MD Morgan, Steven, PharmD Binkley, Shawn, PharmD Sarani, Babak, MD |
| description | Abstract Introduction Delayed administration of effective antimicrobial therapy increases mortality in patients with septic shock. Empiric antibiotic selection in this setting can be inaccurate. The objective of this study was to determine whether an antibiotic algorithm (AA) tailored to institutional resistance patterns improves the adequacy of antimicrobial therapy. Methods A retrospective review of our rapid response system database was performed. Patients with possible sepsis with positive microbiological culture results were enrolled. Pathogens identified by culture were used to determine adequacy of antibiotic selection before and after implementation of an AA. Results A total of 234 patients with septic shock were reviewed (before AA, n = 36; after AA, n = 198). Seventy-two patients had positive cultures and were enrolled (before AA, n = 13; after AA, n = 59). Significantly more patients received adequate coverage after AA implementation (54% vs 86%, P = .02). Before AA, inadequate Gram-negative coverage was the most common reason for failure. Reasons for failure in the after-AA group were nonadherence to the algorithm (n = 5) and multidrug-resistant pathogens (n = 3). The algorithm failed in patients with vancomycin-resistant enterococci (n = 3), multidrug-resistant Klebsiella pneumoniae (n = 1), and Candida albicans (n = 1). Conclusions The use of an AA significantly improves the adequacy of empiric antimicrobial therapy. |
| doi_str_mv | 10.1016/j.jcrc.2011.05.023 |
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Empiric antibiotic selection in this setting can be inaccurate. The objective of this study was to determine whether an antibiotic algorithm (AA) tailored to institutional resistance patterns improves the adequacy of antimicrobial therapy. Methods A retrospective review of our rapid response system database was performed. Patients with possible sepsis with positive microbiological culture results were enrolled. Pathogens identified by culture were used to determine adequacy of antibiotic selection before and after implementation of an AA. Results A total of 234 patients with septic shock were reviewed (before AA, n = 36; after AA, n = 198). Seventy-two patients had positive cultures and were enrolled (before AA, n = 13; after AA, n = 59). Significantly more patients received adequate coverage after AA implementation (54% vs 86%, P = .02). Before AA, inadequate Gram-negative coverage was the most common reason for failure. Reasons for failure in the after-AA group were nonadherence to the algorithm (n = 5) and multidrug-resistant pathogens (n = 3). The algorithm failed in patients with vancomycin-resistant enterococci (n = 3), multidrug-resistant Klebsiella pneumoniae (n = 1), and Candida albicans (n = 1). Conclusions The use of an AA significantly improves the adequacy of empiric antimicrobial therapy.</description><identifier>ISSN: 0883-9441</identifier><identifier>EISSN: 1557-8615</identifier><identifier>DOI: 10.1016/j.jcrc.2011.05.023</identifier><identifier>PMID: 21798704</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Algorithms ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Critical Care ; Decision Support Systems, Clinical ; Emergency Medical Services ; Female ; Hospitals ; Humans ; Infections ; Male ; Middle Aged ; Mortality ; Patient Care Team ; Retrospective Studies ; Shock, Septic - drug therapy ; Treatment Outcome</subject><ispartof>Journal of critical care, 2012-02, Vol.27 (1), p.45-50</ispartof><rights>Elsevier Inc.</rights><rights>2012 Elsevier Inc.</rights><rights>Copyright © 2012 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c471t-ded845b756dca87a683496668687b65ae32e507a61d418a088c4e80ce586868a3</citedby><cites>FETCH-LOGICAL-c471t-ded845b756dca87a683496668687b65ae32e507a61d418a088c4e80ce586868a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1033246847?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21798704$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Miano, Todd A., PharmD</creatorcontrib><creatorcontrib>Powell, Elizabeth, MD</creatorcontrib><creatorcontrib>Schweickert, William D., MD</creatorcontrib><creatorcontrib>Morgan, Steven, PharmD</creatorcontrib><creatorcontrib>Binkley, Shawn, PharmD</creatorcontrib><creatorcontrib>Sarani, Babak, MD</creatorcontrib><title>Effect of an antibiotic algorithm on the adequacy of empiric antibiotic therapy given by a medical emergency team</title><title>Journal of critical care</title><addtitle>J Crit Care</addtitle><description>Abstract Introduction Delayed administration of effective antimicrobial therapy increases mortality in patients with septic shock. Empiric antibiotic selection in this setting can be inaccurate. The objective of this study was to determine whether an antibiotic algorithm (AA) tailored to institutional resistance patterns improves the adequacy of antimicrobial therapy. Methods A retrospective review of our rapid response system database was performed. Patients with possible sepsis with positive microbiological culture results were enrolled. Pathogens identified by culture were used to determine adequacy of antibiotic selection before and after implementation of an AA. Results A total of 234 patients with septic shock were reviewed (before AA, n = 36; after AA, n = 198). Seventy-two patients had positive cultures and were enrolled (before AA, n = 13; after AA, n = 59). Significantly more patients received adequate coverage after AA implementation (54% vs 86%, P = .02). Before AA, inadequate Gram-negative coverage was the most common reason for failure. Reasons for failure in the after-AA group were nonadherence to the algorithm (n = 5) and multidrug-resistant pathogens (n = 3). The algorithm failed in patients with vancomycin-resistant enterococci (n = 3), multidrug-resistant Klebsiella pneumoniae (n = 1), and Candida albicans (n = 1). Conclusions The use of an AA significantly improves the adequacy of empiric antimicrobial therapy.</description><subject>Aged</subject><subject>Algorithms</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Critical Care</subject><subject>Decision Support Systems, Clinical</subject><subject>Emergency Medical Services</subject><subject>Female</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infections</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Patient Care Team</subject><subject>Retrospective Studies</subject><subject>Shock, Septic - drug therapy</subject><subject>Treatment Outcome</subject><issn>0883-9441</issn><issn>1557-8615</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kk2L1TAUhoMoznX0D7iQggvdtOazSUEEGWZUGHChrkOant5J7ce9STvQf-8pd5yBWQwEAuF5D5z3CSFvGS0YZeWnruh89AWnjBVUFZSLZ2THlNK5KZl6TnbUGJFXUrIz8iqljlKmhVAvyRlnujKayh05XrYt-Dmb2syNeOZQh2kOPnP9fophvhmyaczmG8hcA8fF-XVDYTiEuEEPPCLRHdZsH25hzOo1c9kATfCuRxriHkaMzuCG1-RF6_oEb-7uc_Ln6vL3xff8-ue3Hxdfr3MvNZvzBhojVa1V2XhntCuNkFVZlqY0ui6VA8FBUXxnjWTG4apegqEelNkYJ87Jh9PcQ5yOC6TZDiF56Hs3wrQkW3HKeSVoheTHJ0lGKyWVpIwj-v4R2k1LHHEPpITgsjRSI8VPlI9TShFae4hhcHFFyG7qbGc3dXZTZ6myqA5D7-5GLzU2dx_57wqBzycAsLXbANEmH7BWbDmiQttM4en5Xx7FfR_GTdBfWCE97GETt9T-2j7P9ncYo1iUrsQ_V6y91Q</recordid><startdate>20120201</startdate><enddate>20120201</enddate><creator>Miano, Todd A., PharmD</creator><creator>Powell, Elizabeth, MD</creator><creator>Schweickert, William D., MD</creator><creator>Morgan, Steven, PharmD</creator><creator>Binkley, Shawn, PharmD</creator><creator>Sarani, Babak, MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20120201</creationdate><title>Effect of an antibiotic algorithm on the adequacy of empiric antibiotic therapy given by a medical emergency team</title><author>Miano, Todd A., PharmD ; Powell, Elizabeth, MD ; Schweickert, William D., MD ; Morgan, Steven, PharmD ; Binkley, Shawn, PharmD ; Sarani, Babak, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c471t-ded845b756dca87a683496668687b65ae32e507a61d418a088c4e80ce586868a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Aged</topic><topic>Algorithms</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotics</topic><topic>Critical Care</topic><topic>Decision Support Systems, Clinical</topic><topic>Emergency Medical Services</topic><topic>Female</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Infections</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Patient Care Team</topic><topic>Retrospective Studies</topic><topic>Shock, Septic - drug therapy</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Miano, Todd A., PharmD</creatorcontrib><creatorcontrib>Powell, Elizabeth, MD</creatorcontrib><creatorcontrib>Schweickert, William D., MD</creatorcontrib><creatorcontrib>Morgan, Steven, PharmD</creatorcontrib><creatorcontrib>Binkley, Shawn, PharmD</creatorcontrib><creatorcontrib>Sarani, Babak, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Miano, Todd A., PharmD</au><au>Powell, Elizabeth, MD</au><au>Schweickert, William D., MD</au><au>Morgan, Steven, PharmD</au><au>Binkley, Shawn, PharmD</au><au>Sarani, Babak, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of an antibiotic algorithm on the adequacy of empiric antibiotic therapy given by a medical emergency team</atitle><jtitle>Journal of critical care</jtitle><addtitle>J Crit Care</addtitle><date>2012-02-01</date><risdate>2012</risdate><volume>27</volume><issue>1</issue><spage>45</spage><epage>50</epage><pages>45-50</pages><issn>0883-9441</issn><eissn>1557-8615</eissn><abstract>Abstract Introduction Delayed administration of effective antimicrobial therapy increases mortality in patients with septic shock. Empiric antibiotic selection in this setting can be inaccurate. The objective of this study was to determine whether an antibiotic algorithm (AA) tailored to institutional resistance patterns improves the adequacy of antimicrobial therapy. Methods A retrospective review of our rapid response system database was performed. Patients with possible sepsis with positive microbiological culture results were enrolled. Pathogens identified by culture were used to determine adequacy of antibiotic selection before and after implementation of an AA. Results A total of 234 patients with septic shock were reviewed (before AA, n = 36; after AA, n = 198). Seventy-two patients had positive cultures and were enrolled (before AA, n = 13; after AA, n = 59). Significantly more patients received adequate coverage after AA implementation (54% vs 86%, P = .02). Before AA, inadequate Gram-negative coverage was the most common reason for failure. Reasons for failure in the after-AA group were nonadherence to the algorithm (n = 5) and multidrug-resistant pathogens (n = 3). The algorithm failed in patients with vancomycin-resistant enterococci (n = 3), multidrug-resistant Klebsiella pneumoniae (n = 1), and Candida albicans (n = 1). Conclusions The use of an AA significantly improves the adequacy of empiric antimicrobial therapy.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>21798704</pmid><doi>10.1016/j.jcrc.2011.05.023</doi><tpages>6</tpages></addata></record> |
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| subjects | Aged Algorithms Anti-Bacterial Agents - therapeutic use Antibiotics Critical Care Decision Support Systems, Clinical Emergency Medical Services Female Hospitals Humans Infections Male Middle Aged Mortality Patient Care Team Retrospective Studies Shock, Septic - drug therapy Treatment Outcome |
| title | Effect of an antibiotic algorithm on the adequacy of empiric antibiotic therapy given by a medical emergency team |
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