Retrospective Observational Study of the Outcome in the Patients with Serious Hospital Acquired Infections Treated With Empiric Vs Definitive Antibiotic Therapy

INTRODUCTION: Hospital acquired infections occur in the ICUs. The diagnosis of HAI is made by clinical as well as laboratory findings, Although usually samples are sent for cultures, the pick up rate is not satisfactory. OBJECTIVES: To compare the clinical outcomes including survival, ICU length of stay, shock resolution and ventilator free days among groups treated for Hospital associated infections with empiric and definitive antibiotics and thus to provide evidence for optimizing antibiotic selection in serious hospital associated infections, based on clinical outcome potentially reducing ICU stays and improving survival rates. MATERIALS AND METHODS: We studied 31 patients with serious hospital acquired infections admitted to our ICU. The HAI was diagnosed if it occurred 48 hours after admission to the hospital. The clinical diagnosis of pneumonia, BSI or UTI were made by clinical & laboratory criteria. In some patients although the sepsis was diagnosed, the primary site of infection was different or unclear. Cultures were routinely sent. All patients were prescribed antibiotics. The antibiotics were either empirical or as per culture results. We divided the patients into three groups, antibiotics given empirically but changed with the culture report if needed (D) & patients who did not grow anything on cultures and empirical antibiotics continued (E1) or escalated empirically (E2). The primary end point was all cause mortality.(1–4) The secondary endpoints were ICU LOS, resolution of shock if present or ventilator free days. RESULTS: Among 31 patients, the proportion of discharged vs. expired outcomes is not significantly different among the groups (p=0.938). Although there was significantly higher ICU Length of stay in groups treated with definitive antibiotics therapy (p=0.0028), no dfference was noted in terms of ventilator free days (p=0.799) and days until shock resolution (p=0.247) among groups. DISCUSSIONS/CONCLUSIONS: In our study, although HAI cases, which were treated with definitive antibiotic therapy had higher ICU length of stay, neither definitive nor the empirical antibiotics group showed any superiority over another in terms of overall mortality, shock resolution from the day of escalation of antibiotic or ventilator free days. We are planning to perform a prospective study on the same.