Abstract & Commentary
Antibiotic Resistance Patterns in Medical vs Surgical Patients in the Same ICU
By David J. Pierson, MD, Editor, Professor Emeritus, Pulmonary and Critical Care Medicine, University of Washington, Seattle, is Editor for Critical Care Alert.
Synopsis: Over a 2.5-year period, antibiotic resistance patterns of organisms recovered from medical and surgical patients managed by the same intensivist team in the same ICU were indistinguishable. This suggests that reported differences are more likely due to geographic factors and differences in antibiotic usage than to some inherent difference between medical vs surgical ICU patients.
Source: Akulian JA, Metersky ML. Antibiotic resistance patterns in medical and surgical patients in a combined medical-surgical intensive care unit. J Crit Care 2012; Mar 27. [Epub ahead of print.]
In the ICU at the University of Connecticut Health Center, adult patients with both medical and surgical problems are primarily managed by the same team of intensivists. The 234-bed teaching hospital does not manage serious trauma, burns, or organ transplants; patients in the ICU represent general and cardiothoracic surgery, neurosurgery, orthopedics, and non-surgical (that is, medical) patients. This study retrospectively examined the antimicrobial resistance patterns of all bacterial isolates from patients who had been in this unit for more than 1 day during a 2.5-year period. Isolated organisms were categorized in four groups: Staphylococcus aureus; Enterococcus faecalis and E. fecium; non-lactose fermenting gram-negative bacilli; and lactose-fermenting gram-negative bacilli. Antibiotic sensitivities were analyzed for each of these groups, for medical vs surgical patients.
Of 1551 eligible ICU admissions, 265 patients had positive cultures and were included in the study: 171 medical patients with 242 positive cultures and 94 surgical patients with 175 positive cultures. Patient demographics and comorbidity status were not different between the two groups, although surgical patients had been in the hospital and in the ICU substantially longer before the positive culture appeared (3.5 and 2.4 days, respectively, for medical patients, vs 13 and 6.6 days for surgical patients, both P < 0.001). No significant difference in antibiotic resistance was found between medical vs surgical patients for any of the four bacterial groups.
COMMENTARY
Similar patients with ICU-associated infections in different institutions and in different regions may have markedly different causative organisms. A number of studies have found important differences in antimicrobial resistance patterns in organisms recovered from medical vs surgical ICU patients in the same hospital. However, as the authors of the present study point out, those studies have come from institutions with physically separate units and different management teams. This study found similar patterns of antimicrobial resistance in medical and surgical patients managed in a combined medical-surgical ICU by a common intensivist team.
Together, these findings suggest that the antimicrobial resistance patterns manifested by ICU-acquired bacteria in a given unit are more likely to reflect local epidemiologic conditions and antibiotic usage patterns than any inherent differences among patients with surgical and non-surgical illnesses. For the clinician, the message with respect to antimicrobial usage in patients with suspected ICU-acquired infection seems little changed by the findings of this study: Select empirical coverage according to your unit's current bacterial prevalence and antibiogram, as well as the patient's risk factors and clinical condition, and modify it promptly once culture and sensitivity results are available.
In the ICU at the University of Connecticut Health Center, adult patients with both medical and surgical problems are primarily managed by the same team of intensivists.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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