Antibiotic use and impact on outcome from bacteraemic critical illness: The BActeraemia study in intensive care (BASIC)

Corona, A, Bertolini, G, Lipman, J, Wilson, AP and Singer, M (2010) Antibiotic use and impact on outcome from bacteraemic critical illness: The BActeraemia study in intensive care (BASIC). Journal of Antimicrobial Chemotherapy, 65 6: 1276-1285. doi:10.1093/jac/dkq088


Author Corona, A
Bertolini, G
Lipman, J
Wilson, AP
Singer, M
Title Antibiotic use and impact on outcome from bacteraemic critical illness: The BActeraemia study in intensive care (BASIC)
Journal name Journal of Antimicrobial Chemotherapy   Check publisher's open access policy
ISSN 0305-7453
1460-2091
Publication date 2010-06-06
Sub-type Article (original research)
DOI 10.1093/jac/dkq088
Volume 65
Issue 6
Start page 1276
End page 1285
Total pages 10
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Collection year 2011
Language eng
Formatted abstract
Background: The lack of prospective, randomized, controlled trial data to guide optimal antibiotic use in bacteraemic
critically ill patients has led to a wide variety of strategies and major issues with drug resistance. We
therefore prospectively investigated the epidemiology of bacteraemia and fungaemia in intensive care units
(ICUs); and the impact of timing, type and appropriateness of antibiotic intervention.
Methods:
We conducted a multinational, multicentre, prospective observational study in 132 ICUs from 26
countries with no interventions.
Results:
1702 patients [European (69.6%), Australasian (12.2%), South American (8.3%) and Asian (9.9%)]
developed 1942 bacteraemic episodes over the study period. Mortality rates were similar for those receiving
empirical (40.5%), semi-targeted (37.6%) or fully targeted (33.3%) antibiotic therapy (P=0.40), and in those
initially receiving broad- (39.3%) or restricted-spectrum (39.1%) therapy (P=0.94). First-line therapy was effective
in terms of the antibiogram (where available) in 70.4% of cases. This in vitro susceptibility ranged from
76.3% for broad-spectrum antibiotics to 46.3% for restricted-spectrum antibiotics (P<0.0001). However, no
antibiotic policy-associated variable, including in vitro susceptibility (odds ratio 0.89, 95% confidence interval
0.61–1.30), was a statistically significant predictor of mortality.
Conclusions: We could not show an impact of antibiotics on mortality in critically ill patients, despite in vitro
activity and early commencement. Randomized, multicentre trials are urgently needed to establish the appropriate
duration, timing and combinations of antibiotics that will both optimally treat infection and minimize
development of resistance and other complications.
© The Author 2010. Published by Oxford University Press.
Keyword Bloodstream infections
Critically ill patients
Prevalence
Antibiotic strategy
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Medicine Publications
 
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Created: Sun, 30 May 2010, 00:04:08 EST