Antimicrobial therapy in critically ill patients can be started as soon as possible from the time of suspected infection, or after receiving objective data confirming the infection.

Researchers in the United States have suggested that delaying the start of antimicrobial therapy in patients suspected of infection in the intensive care unit (ICU) with a surgical profile until objective data confirming a Nosocomial infection does not negatively affect the death rate in these patients.

To confirm this hypothesis, a 2-year pseudo-experimental observation cohort study was conducted in patients aged 18 years and over hospitalized in ICU of the University of Virginia surgical profile (Charlottesville, Virginia, USA). For the period from September 1, 2008 to August 31, 2009, intensive treatment was prescribed to patients, i.e., patients suspected of nosocomial infection were taken from blood samples for bacteriological examination based on clinical data and immediately ( before receiving the results of a bacteriological blood test) they started antimicrobial therapy. For the period from September 1, 2009 to August 31, 2010, a conservative strategy was used - in this case, antimicrobial therapy was only prescribed after obtaining objective data confirming a nosocomial infection. The primary endpoint of this study was nosocomial mortality.

The number of patients in surgical ICU during 1 and 2 years of the study was 762 and 721 respectively, and the number of patients suspected of nosocomial infection during 1 year of study (intensive management tactics) was 101, during 2 years (conservative management tactics) - 100 people.

Compared to the intensive approach, conservative patient management was associated with a lower mortality rate for all reasons (13/100 (13%) vs 27/101 (27% ), p = 0.015), a higher incidence of prescribing antimicrobial treatment (158/214 (74%) vs 144/231 (62%), p = 0.0095) and a longer duration short of antimicrobial treatment (12.5 days vs 17.7 days, p = 0.008). After adjusting data for age, sex, type of injury, location of infection and APACHE II score, the ratio of risk of death in the intensive care group to management conservative of the patients was 2.5 (95% confidence interval 1.5- 4.0).

Thus, the results of this study demonstrated that waiting for objective data confirming the diagnosis of nosocomial infection and the early management of antibiotic therapy in the event of presumed infection in hospital in surgical patients in ICU n 'does not worsen mortality rates and can lead to more favorable conditions results and use of antimicrobial agents.