This is a multi-center observational cohort study performed over 5 years at two hospital systems. They reviewed over 1800 cases of gram negative bacteremia. About 20% of patients with a prior gram negative bacteremia (within the year) received antibiotics to which their prior cultures were resistant.
This is embarrassing. Just review the prior damn cultures. The answer isnt VancoPime reflexively for everyone. Hell, add on a dose of gentamicin, or whatever the prior cultures are sensitive to. Just write a note in the chart and explain it to the oncoming team.
Side note: bout 25% of admits within the last 90 days were resistant to ceftriaxone and cipro, with an 80% or better percentage for resistance (for ceftriaxone, ceftazidime, meropenem, cipro, or gentamicin – 61% for pip-tazo) to the same antibiotic if the same organism was isolated.
Regardless, blaming the surviving sepsis guidelines or the federal government, or whoever is simply trying to pin your own laziness on someone else. It takes no fewer than 5 minutes – and probably closer to 30 seconds – to review prior cultures. In the critically ill, this is utterly and completely unacceptable.