ArticleIntensive care medicine2007
Antibiotic management of suspected nosocomial ICU-acquired infection: does prolonged empiric therapy improve outcome?
Article in Intensive care medicine, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
24 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- [S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2020Guideline
- Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.Intensive care medicine · 2017Guideline
- A clinical trial comparing physician prompting with an unprompted automated electronic checklist to reduce empirical antibiotic utilization.Critical care medicine · 2013Trial
- Prediction Score ofInternational journal of chronic obstructive pulmonary disease · 2026Article
- Impact of Irrational Use of Antibiotics Among Patients in the Intensive Care Unit on Clinical Outcomes in Sudan.Infection and drug resistance · 2023Article
- Factors Associated With Prolonged Antibiotic Use in the Setting of Suspected Pneumonia and Negative Bronchoalveolar Lavage Cultures.Hospital pharmacy · 2021Article
- Time to blood, respiratory and urine culture positivity in the intensive care unit: Implications for de-escalation.SAGE open medicine · 2021Article
- A Retrospective Analysis of Prolonged Empiric Antibiotic Therapy for Pneumonia Among Adult Neurocritical Care Patients.The Neurohospitalist · 2019Article
- Antibiotic Distribution into Cerebrospinal Fluid: Can Dosing Safely Account for Drug and Disease Factors in the Treatment of Ventriculostomy-Associated Infections?Clinical pharmacokinetics · 2018Review
- Potential Adverse Effects of Broad-Spectrum Antimicrobial Exposure in the Intensive Care Unit.Open forum infectious diseases · 2018Article
- Evaluation of vancomycin therapy in the adult ICUs of a teaching hospital in southern Iran.Drug, healthcare and patient safety · 2018Article
- Empiric antimicrobial therapy in severe sepsis and septic shock: optimizing pathogen clearance.Current infectious disease reports · 2015Article
- Antibiotics against Pseudomonas aeruginosa for COPD exacerbation in ICU: a 10-year retrospective study.International journal of chronic obstructive pulmonary disease · 2015Article
- An alternate pathophysiologic paradigm of sepsis and septic shock: implications for optimizing antimicrobial therapy.Virulence · 2014Review
- De-escalation of empirical therapy is associated with lower mortality in patients with severe sepsis and septic shock.Intensive care medicine · 2014Article
- Prompting physicians to address a daily checklist for antibiotics: do we need a co-pilot in the ICU?Current opinion in critical care · 2013Review
- Duration of antibiotic therapy for critically ill patients with bloodstream infections: A retrospective cohort study.The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale · 2013Article
- Aggressive versus conservative initiation of antimicrobial treatment in critically ill surgical patients with suspected intensive-care-unit-acquired infection: a quasi-experimental, before and after observational cohort study.The Lancet. Infectious diseases · 2012Article
- Empiric antibiotic, mechanical ventilation, and central venous catheter duration as potential factors mediating the effect of a checklist prompting intervention on mortality: an exploratory analysis.BMC health services research · 2012Article
- Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo characterize empiric antibiotic use in patients with suspected nosocomial ICU-acquired infections (NI), and determine the impact of prolonged therapy in the absence of infection. DESIGN AND
settingMulticenter prospective cohort, with eight medical-surgical ICUs in North America and Europe. PATIENTS: 195 patients with suspected NI.
methodsThe diagnosis of NI was adjudicated by a blinded Clinical Evaluation Committee using retrospective review of clinical, radiological, and culture data.
resultsEmpiric antibiotics were prescribed for 143 of 195 (73.3%) patients with suspected NI; only 39 of 195 (20.0%) were adjudicated as being infected. Infection rates were similar in patients who did (26 of 143, 18.2%), or did not (13 of 52, 25.0%) receive empiric therapy (p = 0.3). Empiric antibiotics were continued for more than 4 days in 56 of 95 (59.0%) patients without adjudicated NI. Factors associated with continued empiric therapy were increased age (p = 0.02), ongoing SIRS (p = 0.03), and hospital (p = 0.004). Patients without NI who received empiric antibiotics for longer than 4 days had increased 28-day mortality (18 of 56, 32.1%), compared with those whose antibiotics were discontinued (3 of 39, 7.7%; OR = 5.7, 95% CI 1.5-20.9, p = 0.005). When the influence of age, admission diagnosis, vasopressor use, and multiple organ dysfunction was controlled by multivariable analysis, prolonged empiric therapy was not independently associated with mortality (OR = 3.8, 95% CI 0.9-15.5, p = 0.07).
conclusionsEmpiric antibiotics were initiated four times more often than NI was confirmed, and frequently continued in the absence of infection. We found no evidence that prolonged use of empiric antibiotics improved outcome for ICU patients, but rather a suggestion that the practice may be harmful.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.