Top ten list in antibiotic policy in the ICU.

Over the last decade, the study of mortality in patients with ventilator-associated pneumonia (VAP) has raised a controversial question: whether the patient died of VAP or merely with VAP. Obviously, complications are a major risk in a patient with an infectious disease who does not receive treatment. Equally, if treatment is administered but the antibiotic choice is unsuitable, no beneficial influence on outcome is expected. Decreasing the rate of incorrect prescription is, however, not easy. One option that has demonstrated its reliability as an empirical treatment for ICU infections in recent years is rotation therapy. In this article, the authors report a decrease in the rate of inadequate treatment in previously scheduled empirical antibiotic use. Their multivariate analysis showed that level of severity (as determined by APACHE [acute physiology and chronic health evaluation] II score, the number of organ failures, and the use of vasopressors) and inadequate antimicrobial therapy were significant risk factors for mortality. The adjusted odds ratio of inadequate microbial therapy was 4.22. This approach also produced a significant increase in nosocomial infections. The rate of VAP increased from 11.3% in period 1 to 14.0% in period 3 (p 0.05), and the nosocomial bloodstream infection rate rose from 3.9% in period 1 to 6.8% in period 3 (p 0.05). Further studies are needed to define which empirical antibiotic choice is optimal and to assess in more detail the role of rotation antibiotic therapy as a potential tool for improving outcome.