Utilization of antibiotics in Intensive care unit of the Clinic for anesthesiology, reanimatology and intensive care in University hospital Split depending on blood culture isolates

Cilj istraživanja: Cilj istraživanja bio je retrospektivnom analizom ispitati razlike septičnih pacijenata i onih s bakterijemijom s obzirom na ishod, analizirati najčešće izolate hemokultura i njihovu osjetljivosti na antibiotike, analizirati korištenu antimikrobnu terapiju te prikazati osobitosti ispitanika kao što su indikacija i trajanje liječenja, dobivena antimikrobna terapija i upalni parametri u JIL-u KBC-a Split. Materijali i metode: Retrospektivno kohortno istraživanje provedeno je na temelju analize 323 povijesti bolesti prikupljenih iz pismohrane Klinike za anesteziologiju, reanimatologiju i intenzivno liječenje KBC-a Split za pacijente koje su hospitalizarani u općem JIL-u u razdoblju od 1.siječnja do 31.prosinca 2017. godine. Posebno je izdvojena skupina od 117 ispitanika sa pozitivnom hemokulturom, te unutar nje 49 pacijenata s dijagnozom sepse. Rezultati: Pregledom 323 pripadajuće povijesti bolesti za populaciju obahvaćenu ovim radom dobiven je podatak da je 117 pacijenata (36,22%) imalo hemokulturu pozitivnu i to 68 (21,05% svih pacijenata) bakterijemiju, a 49 (15,17%) sepsu i/ili septički šok. Sepsa i septički šok, uključujući pacijente samo sa kliničkim manifestacijama i one sa mikrobiološkim dokazom, pojavila se u 64 pacijenta (19,81%). U 117 pacijenata s pozitivnom hemokulturom bilo je 198 izoliranih mikroorganizama od čega je 118 (59,60%) Gram pozitivno, 74 (37,37%) Gram negativno i 6 (3,03%) gljiva (4 puta Candida albicans i 2 puta Candida parapsilosis). Najčešći izolati koagulaza negativni Staphylococcus spp. i MRSE najveću su osjetljivost pokazali na vankomicin, teikoplanin, tigeciklin, rifampicin, linezolid i tetraciklin (~70% i više). Lijekovi djelotvorni protiv najčešće izolirane Gram negativne bakterije, multirezistentne Acinetobacter baumannii bili su kolistin (100%) i ampicilin/sulbaktam (92%). Ti su antibiotici proporcionalno zastupljeni u najčešće apliciranim antibioticima u terapiji. Gotovo svaki pacijent primljen u JIL dobije barem jedan antibiotik preventivno. Najčešće se aplicira ceftriakson kao preventivna terapija u pacijenata u kojih se ne sumnja na infekciju i koji su u JIL-u boravili tek nekoliko dana. Broj apliciranih antibiotika direktno je povezan sa trajanjem hospitalizacije. Opća stopa smrtnosti u JIL-u iznosila je 18,57%, a u podskupini bakterijemičnih bolesnika čak i manje, 16,18%. Opća stopa smrtnosti u septičnih pacijenata iznosila je 39,06%, a 36,73% u pacijenata koji su imali i mikrobiološku potvrdu dijagnoze. Očekivano najveća je stopa smrtnosti u septičnih pacijenata bez mikrobiološke potvrde dijagnoze pa i bez smjernica za liječenje, 47%. Zaključak: U JIL-u KBC-a Split ne bilježe se sojevi Acinetobacter baumanni rezistentni na kolistin niti prevladavaju Gram negativni uzročnici i gljive što svjetske studije bilježe kao glavnu otežavajuću okolnost u liječenju infekcija. Prema navedenom zabrinjava postotak smrtnosti od sepse i septičkog šoka koji je visok, iako se ne bilježi toliko velika incidencija.Objectives: The aim of the study was to examine the differences between septic patients and those with bacteremia considering the outcomes, analyzing the most common isolated microorganisms and their sensitivity to antibiotics as well as the most common used antimicrobial therapy and to present the characteristics of respondents such as indication and duration of treatment, antimicrobial therapy and inflammatory parameters in ICU of the Clinic for anesthesiology, reanimatology and intensive care in University hospital Split. Materials and methods: This retrospective cohort research based on the data collected from the archives of Clinic for Anesthesiology, reanimatiology and intesive care in University hospital Split for all patients admitted during the period January 1 to December 31 in year 2017. Results: According to 323 anamnesis related to total number of patients, there were 117 patients with positive blood culture, 68 (21.05%) with bacteremia and 49 (15.17%) with sepsis and septic shock. Including both type of septic patients, with only clinical diagnosis or with microbiological confirmation of the septic state, sepsis and septic shock were diagnosed in 64 (19.81%) patients. There were a total of 198 isolates from the blood culture of which 118 (59.60%) were Gram-positive, 74 (37.37%) Gram-negative and 6 (3.03%) was fungal respectively Candida species (Candida albicans was isolated 4 times and Candida parapsilosis 2 times). Coagulase negative Staphylococcus species and MRSE, two most common isolated microorganisms showed the highest susceptibility to vancomycin, teicoplanin, tigecycline, rifampicin, linezolid and tetracycline (about 70% or more). The most effective antibiotic against the most common isolated Gram negative, multi-resistant Acinetobacter baumannii was colistin (100%) and ampicillin/sulbactam (92%). These antibiotics are proportionally represented in the most commonly used antibiotics in therapy. Nearly every patient admitted to the ICU received at least one antibiotic. The most commonly applied was ceftriaxone as a preventive therapy in patients non susceptible to infection and who stayed in the ICU only a few days. Number of antibiotics applied in therapy directly correlates with the duration of hospitalization. In the entire population, lethal outcome was found in 60 cases (18.57%), in the subgroup of patients with bacteriemia in 11 cases (16.18%), and in septic patients (with microbiological confiramation of diagnosis) in 18 cases (36.73%). The highest mortality was in septic patients without microbiological confirmation of diagnosis and targeted therapy. Conclusions: There were no found prevalence of Gram negative bacteria and fungi neither neither Acinetobacter baumannii strains resistant to colistin as stated as main difficulty in treating infections in many world studies. A worrying fact is mortality rate higher in relation to sepsis and septic shock, although there is no so high incidence