Publication:

Antibiotic efficacy patterns in the critically ill

Background Knowledge of antibiotic sensitivity patterns in the critically ill would lead to better outcomes by refinement of empirical therapy. The aim of the study was to analyze the antibiotic sensitivity patterns of pathogens in the critically ill.

Methods Retrospective analytical study of 267 culture samples from critically ill patients was done. Data was collected from hospital medical records department and analyzed.

Results In case of community-acquired infections, carbapenems and piperacillin-tazobactam had high efficacy for UTI; carbapenems, aminoglycosides and levofloxacin had intermediate efficacy for pneumonia; aminoglycosides, piperacillin-tazobactam, carbapenems and quinolones had intermediate efficacy for soft tissue infections; and linezolid and vancomycin had high efficacy for blood borne sepsis of unknown source. In case of hospital acquired infections, carbapenems and aztreonam had intermediate efficacy for UTI; aminoglycosides had intermediate efficacy for blood borne sepsis of unknown source and aminoglycosides had high efficacy for CLABSI. Only colistin and tigecycline demonstrated high efficacy for VAP. Colistin and tigecycline showed high efficacy for community and hospital acquired UTI, pneumonia and soft tissue infections as well as gram negative CLABSI and hospital acquired blood borne sepsis of unknown source.

Conclusions The study shows that in critically ill, in general, carbapenems are fast losing their efficacy. Colistin and tigecycline are effective even against MDR pathogens in their spectrum. Fluoroquinolones and cephalosporins have poor efficacy overall to be recommended for empirical therapy. Piperacillin-tazobactam is not satisfactory for many critical infections. Amikacin has variable efficacy. Linezolid, vancomycin and teicoplanin are highly active against MRSA and Enterococcus infections.