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Clinical Investigations in Critical CareThe Influence of Inadequate Antimicrobial Treatment of Bloodstream Infections on Patient Outcomes in the ICU Setting
Section snippets
Study Location and Patients
The study was conducted at a university-affiliated urban teaching hospital: Barnes-Jewish Hospital (1,200 beds), in St. Louis, MO. During a 2-year period (July 1997 to July 1999), all patients admitted to the medical ICU (19 beds) and surgical ICU (18 beds) were potentially eligible for this investigation. The medical and surgical ICUs are closed units with dedicated multidisciplinary health-care teams led by board-certified critical care specialists directing patient medical care. The
Patients
A total of 4,913 consecutive eligible patients were prospectively evaluated in the ICU. Among these, 492 patients (10.0%) were identified as having a bloodstream infection and were included in the study cohort (Table 1). The mean age of the patients was 57.8 ± 17.6 years (range, 15 to 102 years), and the mean APACHE II score was 23.4 ± 8.7 (range, 0 to 51). The mean APACHE II score of patients without bloodstream infection from these two ICUs during the same time period (n = 3,299) was 16.5 ±
Discussion
Our study demonstrated that critically ill patients with a bloodstream infection who received inadequate antimicrobial treatment were significantly more likely to die during their hospitalization compared with similar patients with bloodstream infections receiving adequate antimicrobial treatment. We also identified potential risk factors for the administration of inadequate antimicrobial treatment. These risk factors included the presence of a bloodstream infection caused by Candida species,
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Supported in part by grants from the Centers for Disease Control and Prevention (UR8/CCU715087).