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David Kaufman, MD; Curtis E. Haas, PharmD; Rita Edinger, MS; Gary Hollick, PhD

Arch Surg. 1998;133:1041-1045.

Objective  To compare the antibiotic susceptibility of bacterial isolates from patients in the sugical intensive care unit (SICU) with hospital-wide bacterial susceptibility.

Design  Retrospective cohort analytic study.

Setting  Eight-bed SICU in a university-affiliated teaching hospital.

Patients  All hospitalized patients with culture results positive for microorganisms.

Interventions  None.

Main Outcome Measures  Antibiotic susceptibility data were collected retrospectively for all bacterial isolates from SICU patients during July 1, 1994, to June 30, 1995. All duplicate and surveillance cultures were eliminated from the data set. Susceptibility testing was conducted using our standard laboratory methods. Results were compared with the hospital-wide antibiogram (HWA) for the same time period. Comparisons were made using the ² test with Yates correction or the Fisher exact test, as appropriate. Staphylococcus aureus (HWA, n=494; SICU, n=71) was significantly less susceptible to oxacillin (51% vs 28%; P <.001), ciprofloxacin (50% vs 25%; P <.001), erythromycin (46% vs 23%; P<.001), and clindamycin (51% vs 27%; P<.001) in the SICU. Coagulase-negative staphylococci (HWA, n=339; SICU, n=37) were significantly less susceptible to oxacillin (33% vs 16%; P=.04) and clindamycin (57% vs 34%; P=.02). Pseudomonas aeruginosa (HWA, n=513; SICU, n=96) was less susceptible to imipenem (85% vs 74%, P =.01) and more susceptible to ticarcillin–clavulanic acid (88% vs 100%, P<.001) in the SICU. Escherichia coli (HWA, n=474; SICU, n=36) was more susceptible to most penicillin-derivative antibiotics in the SICU (ampicillin [68% vs 83%, P=.06], ticarcillin [65% vs 86%, P =.01], mezlocillin [76% vs 95%, P=.01], and ticarcillin–clavulanic acid [88% vs 100%, P=.02]).

Conclusions  The 2 most commonly isolated bacterial pathogens in the SICU (S aureus and P aeruginosa) had significantly different susceptibility patterns compared with the HWA. Surprisingly, E coli isolated in the SICU tended to be more susceptible to penicillin-derivative antibiotics. These data indicate that empiric antibiotic choices in the SICU may be better guided by unit-specific antibiograms.

From the Departments of Surgery (Dr Kaufman), Pharmacy (Dr Haas), and Clinical and Laboratory Medicine (Ms Edinger and Dr Hollick), Rochester General Hospital, Rochester, NY.

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