Clinical outcomes and mortality risk factors among intensive care unit patients with bacteremia at a university hospital
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Abstract
This study aimed to determine the prevalence and antimicrobial susceptibility of causative pathogens associated with 30-day mortality among intensive care unit (ICU) patients with bloodstream infections as well as to analyze clinical outcomes and risk factors. This retrospective study was conducted at Phramongkutklao Hospital, Thailand, between October 2017 and December 2018. The study included 142 patients with bloodstream infections caused by 193 isolated pathogens. Of the 142 patients, the clinical cure and death rates were reported to be 40.1% and 62.0%, respectively. Of the 193 isolated bacterial strains, 83.4% were Gram-negative: predominately Klebsiella pneumoniae, followed by Acinetobacter baumannii, and then Pseudomonas aeruginosa isolates. Gram-positive bacteria accounted for 16.6% of the total isolated bacterial strains: Staphylococcus aureus was the leading isolate, followed by coagulase-negative staphylococci and then Enterococcus faecalis. Most of the A. baumannii isolates (97.0%) were resistant to meropenem, but 57.7% of P. aeruginosa and 40.0% of K. pneumoniae were susceptible to meropenem. Through multivariate analysis, it was found that the significant factors for 30-day mortality were male gender, catheter-related bloodstream infection, and carbapenem-resistant Gram-negative infection. Due to the high 30-day mortality rate of almost two-thirds of the study groups, healthcare professionals are challenged to select an optimized treatment regimen for ICU patients with carbapenem-resistant gram-negative infection.
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