Critically-ill patients are more susceptible to infections, making antibiotic use a common strategy to improve outcomes of patients at risk for sepsis. But overuse of antibiotics can lead to pathogen resistance and subsequent infections.
Vanderbilt researchers established a program in 2002 in attempt to limit the potential impact of multidrug resistant infections; the program not only worked, but the findings have now been published in the journal Surgical Infections.
“People tend to take a nihilistic approach to limiting pathogen resistance because it’s so hard to believe you can change that, said Addison May, M.D., director of Surgical Critical Care and senior author of the study.
“However, our results over the last 10 years of this study clearly indicate you can dramatically alter pathogen resistance in your intensive care unit.”
May estimates that 80 percent of critically-ill patients come in with symptoms of systemic inflammatory response, including fever, elevated white count and increased respiratory rate.
“Only about 20 percent of those patients actually have an infection,” he said. “Reducing the over-diagnosis of infections by requiring more precise diagnostic techniques helped to reduce our antibiotic exposure significantly.”
Marcus Dortch, Pharm.D., clinical pharmacist of Surgical Critical Care and lead author of the study, said the trauma and surgical intensive care units became more aggressive in seeking empirical evidence of infections to ensure antibiotics are properly prescribed and not overused.
“Use of order sets and making antibiotic use more consistent across the board helped us maintain compliance with the new schedule protocol,” he said.
The researchers’ next step is to examine current antibiotic use to see if they can be reduced to more narrow-spectrum, less toxic and less expensive medications.
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