Clinical outcomes and mortality risk factors among intensive care unit patients with bacteremia at a university hospital

Main Article Content

Wichai Santimaleeworagun
Petch Wacharasint
Weerayuth Saelim
Juthathip Suphanklang
Kawin Duangmee
Narisa Ruenroengbun
Pachara Thiengkumdee
Sukhontha Ratchadawan
Duangspan Tewthao
Thanathorn Kulkiatprasert

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.

Downloads

Download data is not yet available.

Article Details

Section
Health sciences

References

Al Mayahi, Z., Kamel, S., Amer, H., and Beatty, M. (2019). Outbreak of colistin-resistant organisms at a tertiary hospital in Riyadh, Saudi Arabia, 2016. The Pan African Medical Journal, 34, 162.

Campion, M., and Scully, G. (2018). Antibiotic use in the intensive care unit: optimization and de-escalation. Journal of Intensive Care Medicine, 33(12), 647-655.

Centers for Disease Control and Prevention. (2018). Identifying Healthcare-Associated Infections (HAI) for NHSN Surveillance. [Online URL: https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf] accessed on April 10, 2019.

Fraser, A., Paul, M., Almanasreh, N., Tacconelli, E., Frank, U., Cauda, R., Borok, S., Cohen, M., Andreassen, S., Nielsen, A. D., and Leibovici, L. (2006). Benefit of appropriate empirical antibiotic treatment: thirty-day mortality and duration of hospital stay. The American Journal of Medicine, 119(11), 970-976.

Guducuoglu, H., Gursoy, N. C., Yakupogullari, Y., Parlak, M., Karasin, G., Sunnetcioglu, M., and Otlu, B. (2018). Hospital outbreak of a colistin-resistant, NDM-1- and OXA-48-producing Klebsiella pneumoniae: high mortality from pandrug resistance. Microbial Drug Resistance, 24(7), 966-972.

Gupta, V., Ye, G., Olesky, M., Lawrence, K., Murray, J., and Yu, K. (2019). National prevalence estimates for resistant Enterobacteriaceae and Acinetobacter species in hospitalized patients in the United States. International Journal of Infectious Diseases, 85, 203-211.

Khwannimit, B., and Bhurayanontachai, R. (2009). The epidemiology of, and risk factors for, mortality from severe sepsis and septic shock in a tertiary-care university hospital setting. Epidemiology and Infection, 137(9), 1333-1341.

Kim, T., Park, K. H., Yu, S. N., Park, S. Y., Park, S. Y., Lee, Y. M., Jeon, M. H., Choo, E. J., Kim, T. H., Lee, M. S., and Lee, E. (2019). Early intravenous colistin therapy as a favorable prognostic factor for 28-day mortality in patients with CRAB bacteremia: a multicenter propensity score-matching analysis. Journal of Korean Medical Science, 34(39), e256.

Kovitangkoon, K., Putthanachote, N., Sangsa, N., Kaewmafai, J., and Sarakran, K. (2017). Factors associated with bacterial septicemia among patients in intensive care unit, Roi Et hospital, Roi Et province. Srinagarind Medical Journal, 32(2), 111-118. [in Thai]

Lie, K. C., Lau, C., Chau, N. V. V., West, T. E., Limmathurotsakul, D., and The Southeast Asia Infectious Disease Clinical Research, N. (2018). Utility of SOFA score, management and outcomes of sepsis in Southeast Asia: a multinational multicenter prospective observational study. Journal of Intensive Care, 6, 9.

Mansour, W., Haenni, M., Saras, E., Grami, R., Mani, Y., Ben Haj Khalifa, A., Atrouss, S., Kheder, M., Fekih Hassen, M., Boujâafar, N., Bouallegue, O., and Madec, J. Y. (2017). Outbreak of colistin-resistant carbapenemase-producing Klebsiella pneumoniae in Tunisia. Journal of Global Antimicrobial Resistance, 10, 88-94.

Mayr, V. D., Dunser, M. W., Greil, V., Jochberger, S., Luckner, G., Ulmer, H., Friesenecker, B. E., Takala, J., and Hasibeder, W. R. (2006). Causes of death and determinants of outcome in critically ill patients. Critical Care, 10(6), R154.

McCann, E., Srinivasan, A., DeRyke, C. A., Ye, G., DePestel, D. D., Murray, J., and Gupta, V. (2018). Carbapenem-nonsusceptible gram-negative pathogens in ICU and non-ICU settings in US hospitals in 2017: a multicenter study. Open Forum Infectious Diseases, 5(10), ofy241.

Prawang, A., Santimaleeworagun, W., Changpradub, D., Thunyaharn, S., and Puttilerpong, C. (2019). Treatment and clinical outcomes among infected patients with colistinresistant Klebsiella pneumoniae bacteremi. Open Forum Infectious Diseases, 6, S782-S783.

Santimaleeworagun, W., Thunyaharn, S., Juntanawiwat, P., Thongnoy, N., Harindhanavudhi, S., Nakeesathit, S., and Teschumroon, S. (2020). The prevalence of colistin-resistant gram-negative bacteria isolated from hospitalized patients with bacteremia. Journal of Applied Pharmaceutical Science, 10(2), 056-059.

Sterling, S. A., Miller, W. R., Pryor, J., Puskarich, M. A., and Jones, A. E. (2015). The impact of timing of antibiotics on outcomes in severe sepsis and septic shock: a systematic review and meta-analysis. Critical Care Medicine, 43(9), 1907-1915.

Teerawattanapong, N., Kengkla, K., Dilokthornsakul, P., Saokaew, S., Apisarnthanarak, A., and Chaiyakunapruk, N. (2017). Prevention and control of multidrug-resistant gram-negative bacteria in adult intensive care units: a systematic review and network meta-analysis. Clinical Infectious Diseases, 64, S51-S60.

The National Antimicrobial Resistant Surveillance Thailand. (2018). Antibiogram. [Online URL:http://narst.dmsc.moph.go.th/] accessed on April 10, 2020.

Vincent, J. L., Bihari, D. J., Suter, P. M., Bruining, H. A., White, J., Nicolas-Chanoin, M. H., Wolff, M., Spencer, R. C., and Hemmer, M. (1995). The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) study. EPIC international advisory committee. Journal of the American Medical Association, 274(8), 639-644.

Vincent, J. L., Rello, J., Marshall, J., Silva, E., Anzueto, A., Martin, C. D., Moreno, R., Lipman, J., Gomersall, C., Sakr, Y., and Reinhart, K. (2009). International study of the prevalence and outcomes of infection in intensive care units. Journal of the American Medical Association, 302(21), 2323-2329.

Vincent, J. L., Sakr, Y., Singer, M., Martin-Loeches, I., Machado, F. R., Marshall, J. C., Finfer, S., Pelosi, P., Brazzi, L., Aditianingsih, D., Timsit, J., Du, B., Wittebole, X., Máca, J., Kannan, S., Gorordo-Delsol, L. A., De Waele, J. J. Mehta, Y., Bonten, M. J. M., Khanna, A. K., Kollef, M., Human, M., Angus, D. C., and EPIC III Investigators. (2020). Prevalence and outcomes of infection among patients in intensive care units in 2017. Journal of the American Medical Association, 323(15), 1478-1487.