PURPOSE: Timely and appropriate administration of antimicrobial therapy is instrumental to optimizing outcomes in infected critically ill patients (Kollef MH et al, Chest 1999; 115:462). Use of novel technologies such as remote monitoring may augment care delivery in this population. We sought to determine the utility of a culture review and intervention routine in intensive care patients served by our eICU.
METHODS: We retrospectively reviewed all culture results identified by quality routine (eICU night shift intensivist review of all new cultures generated within 12 hours prior to shift) that led directly to interventions for the 4-month period between 27 December 2007 and 27 April 2008. Relevant variables determined from review included pathogen type, location of infection, time from culture result to intervention, indication for intervention, and specific type of intervention.
RESULTS: During the study period, 16 distinct interventions were performed as indicated by culture review an average of 11.9 hours after result. In nine of these, new pathogens were identified; in the other seven, susceptibility results were updated. Specific pathogens were identified in 15 cases and were particularly fastidious (including Staphylococcus aureus in 5, Pseudomonas aeroginosa in 4, Enterobacter spp. in 2, Candida spp. in 2). Infection sites were predominantly sputum (7) and urine (6), and resulted in expedited change in antimicrobial regimen in 12 instances and replacement of bladder catheter in 4.
CONCLUSION: Use of an eICU culture review routine occasionally led to earlier and more appropriate antimicrobial therapy in monitored patients. Cultured organisms requiring a change in therapy were reflective of the population studied.
CLINICAL IMPLICATIONS: Structured use of remote monitoring technology (with attendant review of results from multiple facilities and empowered computerized physician order entry) may enhance treatment of infection in the critically ill.
DISCLOSURE: William Jackson, No Financial Disclosure Information; No Product/Research Disclosure Information