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LONDON -- Experts in intensive care and infection from the Academy for Infection Management (AIM) have emphasized the important role they can play in helping free up beds in intensive care units (ICUs), following publication of a report by the Intensive Care Society (1) last week which underlined a serious shortage of ICU beds in the UK.
The global group of infection specialists highlighted research demonstrating that earlier use of an appropriate antibiotic not only improves the outcome for seriously ill patients, but results in a significant reduction in the time that they need to remain in ICU (3.1 days less, p<0.001).(2) In the study, of all patients who are recognized as having an infection while in ICU, 25 percent receive inadequate treatment to manage their infection effectively.(2)
"Hospital-acquired infection is an increasingly serious problem in the UK, and is one of the factors contributing to the mounting pressure on ICU beds," commented Robert Masterton, medical director of Ayrshire and Arran Acute Hospitals NHS Trust, and member of the AIM board. "We are working closely with ICU specialists to help them recognize the importance of prescribing the most suitable antibiotics as soon as an infection has been diagnosed. This will minimize the risk to patients, and help them get out of hospital earlier".
One of the key AIM objectives is to encourage use of early appropriate therapy; that is, giving broad spectrum antibiotics before the results of laboratory tests, which can take up to two days, are available. The sooner an antibiotic is given after a suspected bacterial infection has been diagnosed, the more effectively it can be controlled -- assuming the causative bacteria are susceptible. This is more likely to be the case if a broad spectrum antibiotic is given, which is known to be effective against the likely range of causative pathogens.
However, some healthcare professionals may hesitate in prescribing effective broad spectrum antibiotics to patients with a suspected bacterial infection because one of the principal concerns in the management of hospital-acquired infection is the development of resistance to antibiotics . This means that potent antibiotics, for example the carbapenems such as meropenem are often 'held in reserve,' despite compelling evidence that their antibacterial activity (3) makes them strong candidates for early use.
Additionally, pathogens tend to develop resistance to the majority of traditionally used antibiotics. However, as Robert Masterton explains: "Meropenem is a powerful ultra-broad spectrum antibiotic, which is effective on a large range of pathogens, and to which bacterial resistance is not commonly seen and has not been increasing". An ongoing seven-year study known as MYSTIC (Meropenem Yearly Susceptibility Test Information Collection) has been specifically undertaken to collect information on this drug to demonstrate its sustained potency. (4)
In speaking about the early use of broad-spectrum antibiotics to improve outcomes and reduce the burden on intensive care, Robert Masterton summarized, "As the ICU bed shortage continues, Trusts will need to assess potential benefits from changing their antibiotic prescribing policies. Better use of antibiotics will not only save lives - it will free up ICU beds too."
2. Kollef MH, Sherman G, Ward S, Fraser VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 1999; 115 (2): 462-474
3. Garcia Rodriguez JA, Jones RN. Antimicrobial resistance in gram- negative isolates from European intensive care units: Data from the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Programme. Journal of Chemotherapy 2002;14(1):25-32
4. Turner PJ et al. Meropenem Yearly Susceptability Test Information Collection (MYSTIC). J Antimicrob Chemother 2000; 46 (Supp T2): p9-23
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