Empirical antibiotic choice for the seriously ill patient: Are minimization of selection of resistant organisms and maximization of individual outcome mutually exclusive?

Paterson, David L. and Rice, Louis B. (2003) Empirical antibiotic choice for the seriously ill patient: Are minimization of selection of resistant organisms and maximization of individual outcome mutually exclusive?. Clinical Infectious Diseases, 36 8: 1006-1012. doi:10.1086/374243


Author Paterson, David L.
Rice, Louis B.
Title Empirical antibiotic choice for the seriously ill patient: Are minimization of selection of resistant organisms and maximization of individual outcome mutually exclusive?
Journal name Clinical Infectious Diseases   Check publisher's open access policy
ISSN 1058-4838
Publication date 2003-04-15
Sub-type Article (original research)
DOI 10.1086/374243
Volume 36
Issue 8
Start page 1006
End page 1012
Total pages 7
Place of publication Chicago, I.L., U.S.A.
Publisher Chicago University Press
Language eng
Subject 1115 Pharmacology and Pharmaceutical Sciences
1108 Medical Microbiology
1103 Clinical Sciences
Abstract Mortality related to serious infections in intensive care units (ICUs) is highest if empirical therapy is not active against the organism causing the infection. However, excessive empirical therapy undoubtedly contributes to bacterial resistance to antibiotics, in turn potentially contributing to poor patient outcome. We have reviewed 3 strategies that are increasingly practiced to reduce the hazards of broad empirical therapy, while aiming to ensure that empirical therapy is adequate. The most widely practiced strategy is discontinuation or streamlining of empirical therapy when culture results are available. The second approach is to withdraw certain antibiotic classes (most notably, third‐generation cephalosporins) from the ICU antibiotic armamentarium. The third strategy employed is antibiotic cycling. Although this has also appeared to be a successful strategy, currently published studies have used historical controls and thus may be subject to significant bias. Computer‐assisted antibiotic prescribing in ICUs may supplement or replace such strategies in the future. units
Keyword Nosocomial infections
Empirical therapy
Inadequate Antimicrobial Treatment
Intensive care units
Beta-Lactamases
Cephalosporin Use
Management Program
Enterococcus-faecium
Mouse Gastrointestinal-tract
Gram-negative Bacilli
Ventilator-associated Pneumonia
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
UQ Centre for Clinical Research Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 53 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 72 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Mon, 04 Jan 2010, 16:08:05 EST by Michael Affleck on behalf of UQ Centre for Clinical Research