DEW RB, SULLIVAN D, PINO RM; Interscience Conference on Antimicrobial Agents and Chemotherapy (43rd: 2003: Chicago, Ill.).

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2003 Sep 14-17; 43: abstract no. K-452c.

Massachusetts General Hospital, Boston, MA.

BACKGROUND: Nosocomial infections in patients(px) in medical ICU's are associated with significant morbidity and mortality. Various surveillance systems are demonstrating an increase in resistance (resist) to commonly used antibiotic(abx) regimens. Understanding the outcomes and costs of this resist could improve the abx therapy in critically ill px. METHODS: We evaluated nosocomial gram negative isolates during 2 time periods over a 2 year period. Prior abx therapy, source of culture and susceptibility utilizing custom MIC panels were collected and analyzed. Hospital resource utilization was collected utilizing the Eclipsys SDSM (TSI) system. Outcomes were compared utilizing susceptibility (S) to ceftazidime as a marker of resistance (R). RESULTS: Over the 2 time periods, 104 isolates from 71 px were collected. The isolates were primarily from respiratory tract and bronchoscopy sources (61%). Predominant pathogens (%) were: Pseudomonas spp. (23), Klebsiella spp. (19.2), Enterobacter spp. (14.4), E. coli (13.5) and Acinetobacter spp. (11.5). Institutional abx usage reflected the following (defined daily doses): levofloxacin (35,000); cephalosporins - 3rd & 4th generation (35,000); vancomycin (35,000); carbapenems (6,000). MICU stay ranged from 2-96 days (D) with hospital mortality reaching 58 and 54.5% in the 2 time periods. Separating px by ceftazidime susceptibility, resist px had longer ICU LOS (12.4; p <0.02); mechanical ventilator days (MVD) (18; p <0.02); Hospital LOS was longer (15.64, NS); Total costs (54% increase) and Pharmacy costs (149% increase) were higher in the resist group. Px severity of illness was similar based on AP-DRG. Mortality was similar in both groups (S 55.5% R 53.8%). CONCLUSIONS: Nosocomial infections in a MICU consume considerable resources. Development of resist to commonly used cephalosporins are associated with a significant increase in ICU LOS, MVD and hospital cost. {Supported in part by a grant from Merck and Co., Inc., West Point, PA.}

Publication Types:

• Meeting Abstracts

Keywords:

• Anti-Bacterial Agents
• Ceftazidime
• Cephalosporins
• Costs and Cost Analysis
• Critical Illness
• Cross Infection
• Enterobacter
• Hospital Costs
• Hospital Mortality
• Humans
• Intensive Care Units
• Microbial Sensitivity Tests
• Ventilators, Mechanical
• economics
• methods

Other ID:

• GWAIDS0025770

UI: 102265394

From Meeting Abstracts