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AbstractPurpose:The Scientific Studies Committee of the Surgical Infection Society undertook the present study to examine the prevalence of and indications for antimicrobial use in intensive care units where members of the Society practice.Methods:Information and data collection sheets were posted on the Internet for download by members interested in participating. All centers were required to obtain approval from their local human subjects research office or equivalent. A one-week time was set during which the center could collect information on any one day, at the center's convenience. Data collection sheets were then sent to the lead author for analysis. Seventeen centers reported data for 371 patients in 22 intensive care units.Results:Trauma and general surgical patients comprised 224 of the patients (60). The indications for anti-infective agents were prophylactic (22), empiric (27), therapeutic with known pathogen (41), therapeutic without known pathogen (e.g., cellulitis) (4), insistence of influential practitioner (4), or non-anti-infective purposes (e.g., erythromycin for gastric motility) (2). Only 44, 29, and 54 of the orders for prophylactic, empiric, and therapeutic antibiotics, respectively, had date-certain stop dates. The antimicrobial drugs most commonly used were vancomycin, piperacillin-tazobactam, and fluconazole.Conclusion:Most patients were receiving antimicrobial agents. Polypharmacy was common. Most patients did not have a date-certain stop date. This study sets the benchmark for future study regarding antibiotic prescribing behavior in surgical intensive care units. [ABSTRACT FROM AUTHOR]

Background Multi-drug resistant (MDR) organisms in intensive care units (ICUs) are a growing concern. The emergence of several infections with MDR Acinetobacter baumanniiprompted a review of cases and evaluation of the efficacy of intervention.Objective To determine the rate of clinical cure, the incidence of drug resistance, and the mortality rate associated with A. baumanniiinfection.Method Retrospective review of A. baumanniiinfections in three surgical ICUs between January, 2004 and November, 2005. Infection was identified in 291 patients, 20 of whom were excluded because of incomplete documentation. Of the remaining 271 patients, 71 were male, and the mean age was 47 ± 18 years (range 13–90 years).Results Patients had a mean length of stay in the ICU of 14 days (range 0–136 days) before infection. The initial positive cultures were from bronchoalveolar lavage fluid (BAL) in 72.3, blood in 16.2, a catheter tip in 6.3, urine in 1.8, wound in 2.2, and abscess in 1.1. In 46.9 of patients, the first culture was polymicrobial. The Acinetobacterisolates were resistant or intermediate-resistant to imipenem–cilastatin in 81.2 of cases; 19.9 were resistant to all drugs except colistin, and two were resistant to all tested drugs. Colistin was used in 75.6 of patients (intravenous 61.5, nebulized 38.5). The mean duration of treatment was 13 ± 8.9 days (range 0–56 days), and clinical cure was achieved in 73.8 of patients. Recurrent infection after initial cure was found in 19.2 of patients. There was no significant difference in clinical cure rates between patients treated with colistin and those treated with other culture-directed drugs (75.1 vs. 69.7), or between patients treated with intravenous vs. nebulized colistin (72.4 vs. 79.5). The mortality rate was 26.2 for the entire group and was significantly higher in the subgroup of transplant patients (n 31) (64.5 vs. 21.4; p < 0.001).Conclusion The majority of A. baumanniiisolates were MDR, and a significant proportion were sensitive only to colistin. Treatment of A. baumanniiinfection with colistin is effective by both intravenous and nebulized routes of administration. However, infection with A. baumanniiin critically ill surgical patients is associated with a high mortality rate, particularly in transplant patients. [ABSTRACT FROM AUTHOR]

Background Complicated intra-abdominal infections are a common problem in surgical practice. This study compared the effectiveness of ertapenem (1 g qd) and piperacillintazobactam (3.375 g q6h) in the treatment of these infections.Methods This was a multicenter, double-blinded, randomized study conducted in patients with complicated intra-abdominal infections. Of the 535 patients screened, 500 were stratified on the basis of disease severity (Acute Physiology and Chronic Health Evaluation [APACHE] II score ≤10 or >10), then randomized (11) to 4–14 days of treatment with one of the regimens and six weeks of followup. Nearly all patients (N 494) were treated. The primary endpoint was the proportion of microbiologically evaluable patients with a favorable clinical response (cure) at two weeks. Non-inferiority of ertapenem was based on a difference in response rate of <15 percentage points compared with piperacillintazobactam (lower bound of the 95 CI > −15).Results Of the 494 treated patients, 231 were microbiologically evaluable, with 123 and 108 patients in the ertapenem and piperacillintazobactam groups, respectively. Statistically similar cure rates were observed in the ertapenem (82.1) and piperacillintazobactam (81.7) groups (difference 0.3 [95 CI −9.6, 10.5]). The pathogens isolated most frequently were Escherichia coli, Bacteroides fragilis, and Bacteroides thetaiotamicron, typical isolates associated with intra-abdominal infections. There were no statistical differences between the groups in serious drug-related clinical adverse events, drug-related clinical adverse experiences leading to study discontinuation, or mortality.Conclusions Ertapenem was non-inferior to piperacillintazobactam in the cure of intra-abdominal infections caused by susceptible pathogens. Both study drugs generally were well tolerated. [ABSTRACT FROM AUTHOR]