The impact of isolated bacteria resistance on treatment outcome in patients with Gram negative sepsis at the Intensive Care Unit at University Hospital Centre Zagreb

Sepsa je upalni odgovor organizma na prisutnost bakterija i njihovih toksina u organizmu. Liječenje sepse temelji se na eradikaciji uzročnika, održavanju hemodinamike i liječenju organske disfunkcije. Mnogi uzročnici sepse razvili su rezistenciju na antibiotike te empirijska terapija ponekad nije učinkovita, što može rezultirati nepovoljnim ishodom. Istraživanje je temeljeno na retrospektivnoj studiji populacije bolesnika liječenih u Zavodu za intenzivnu medicinu Kliničkog bolničkog centra Zagreb u trogodišnjom razdoblju od 01.01.2013. do 31.12.2015. tijekom kojeg su zabilježene 1962 hospitalizacije. Podaci o broju bolesnika, izolatima te antibiogramima prikupljeni su iz aplikacije bis (bolnički informacijski sustav) te bili upisivani u tabličnom obliku, a nakon toga statistički obrađeni u programu Statistical Package for the Social Sciences (SPSS). Iz pozitivnih hemokultura bilježena je osjetljivost izoliranih Gram negativnih uzročnika i promatran je ishod bolesnika. Udio bolesnika hospitaliziranih u Zavodu s dokazanom Gram negativnom sepsom konstantan je kroz trogodišnje razdoblje i kreće se oko 7%. Pseudomonas aeruginosa je najčešći izolat u bolesnika s Gram negativnom sepsom s visokim udjelom rezistencije 29 od 53 izolata, odmah nakon Acinetobactera u kojeg je 25 od 27 izolata multirezistentno. Učestalost izolata P. aeruginosa u bolesnika s Gram negativnom sepsom raste kroz promatrano razdoblje od tri godine. Ishod je najnepovoljniji kod miješane Gram negativne sepse uzrokovane s dva ili više uzročnika, a od pojedinačnih uzročnika najnepovoljniji je kod infekcije uzrokovane nonfermentorima P. aeruginosa i A. baumannii u kojih je i udio rezistencije najveći. Bolesnici s Gram negativnom sepsom uzrokovanom multirezistentnim bakterijskim sojevima imaju značajno veću smrtnost od bolesnika čija je sepsa uzrokovana osjetljivom sojevima.Sepsis is a clinical syndrome that occurs as the result of invasion of bacteria and their toxins into the circulation which causes an inflamatory sistem response. The treatment of sepsis is based on the eradication of isolated microorganisms, maintance of haemodynamics and treatment of organ dysfunction. Most causes of sepsis developed a resistance to antibiotics. Therefore, empiric antibiotic therapy can be inefficient, which can result with an adverse outcome. A three – year retrospective study was conducted in patients hospitalized at the Intensive care unit in University Hospital Centre Zagreb from 1 January 2013 until 31 December 2015. During this period 1962 patients were observed. Data about numbers of patients, isolated microorganisms and results of antibiograms were collected from bis application (hospital system of informatization), written up in tables and statistically processed in the Statistical Package for the Social Sciences SPSS. Resistance of Gram negative microorganisms and outcome of patients were collected. The percentage of patients with Gram negative sepsis hospitalized in the Department was stable and around 7%. P. aeruginosa was the most common isolate, with a high percentage of multiresistance (29/35 isolates), right after A. baumannii (25/27). The incidence of P. aeruginosa isolatesbacteria on the increase. The outcome was the worst in mixed Gram negative sepsis caused with 2 or more microorganisms, while among individual bacterial species the outcome was the worst in infections caused by non fermenters P. aeruginosa and A. baumannii, which have the highest percentage of multiresistance. Patients with Gram negative sepsis caused by multiresistant bacterial strains had a significaly higher mortality than patients with sepsis caused by sensitive strains