The influence of empiric antimicrobial therapy on acquired pulmonary infection in patients with a chest injury on ICU

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Introduction

Infections acquired in the intensive care unit (ICU) commonly complicate the course of critical illness. The administration of empiric antibiotics was identified as an independent risk factor for the development of subsequent nosocomial infection [1]. The aim of our study was to evaluate the influence of empiric antimicrobial therapy on the acquired pulmonary infection in patients with a chest injury on interdisciplinary ICU.

Methods

We analyzed a prospectively-collected database of 64 patients with a chest injury admitted for at least four days to the interdisciplinary ICU of university hospital in 1999. Patients were retrospectively divided into a group receiving, from admission to the ICU, antimicrobial therapy (ATB group, n=41) and a group without antimicrobial therapy during first 48 h after admission (No ATB group, n=23). The age, APACHE II, ISS, TRISS, length of ICU stay, duration of mechanical ventilation, rate of isolated chest injury and associated diagnoses (multiple injury, abdominal injury, head injury), ICU mortality, and rate of acquired pulmonary infection were evaluated. Χ² test, Mann-Whitney and unpaired t-test were used accordingly; P<0.05 was considered statistically significant.

Results

No differences in most of the parameters were found between groups, except for the length of ICU stay, duration of mechanical ventilation and the incidence of acquired pulmonary infection (Table 1).

Table 1 Data expressed as mean ±SD, *=P>0.05, NS=non-significant

Conclusions

Empiric antimicrobial therapy in patients with the chest injury on ICU may increase the rate of pulmonary infections, prolong duration of mechanical ventilation and extend the time of ICU stay. There is a need for controlled studies to define the role of antibiotics in empiric therapy in trauma patients.