The blood culture results and treatment outcome in the Intensive care unit

Ciljevi istraživanja: Identificirati patogene mikroorganizme u uzorcima za hemokulturu, ispitati njihovu osjetljivost na antibiotike i povezati izolirane uzročnike s konačnim stanjem i ishodom pacijenata. Nacrt studije: presječno istraživanje Materijal i metode: U istraživanje je bilo uključeno 123 pacijenta koji su bili smješteni na JIL-u razdoblju od siječnja 2018. do prosinca 2018. godine. Pacijentima su analizirane povijesti bolesti, terapijske liste i ukupno 482 uzorka hemokulture. Identificirali su se patogeni mikroorganizmi izolirani u hemokulturama i opisana je osjetljivost najčešće izoliranih bakterija. Usporedila se antibiotska terapija na dan uzimanja uzoraka hemokulture s terapijom nakon dospijeća pozitivnih nalaza hemokulture. Korištene statističke metode jesu: t-test, x2 test, Fisherov egzaktni test, Mann-Whitney test te Pearsonov koeficijent korelacije. Rezultati: Prosječna dob ispitanika iznosila je 63 godine. Ukupno 33 od 123 pacijenta (27 %) imalo je pozitivnu hemokulturu. U izolatima hemokulture najčešće izolirani mikroorganizmi bile su gram pozitivne bakterije, od kojih je najčešće izoliran MRKNS. Najčešće uvedeni antibiotici bili su: meropenem, metronidazol, vankomicin i kolistin. Pacijentov duži boravak u JIL-u značio je i veći broj korištenih antibiotika (r = 0,296; P = 0,002). Pacijenti kod kojih je dokazan patološki izolat na dan uzorkovanja u terapiji najčešće su imali kolistin i kloksacilin, dok je najčešće ordinirani antibiotik nakon dospijeća pozitivnog nalaza hemokulture bio meropenem. Preminulo je ukupno 48 pacijenata (39 %), od kojih je njih 10 imalo jedan ili više pozitivnih nalaza hemokulture. Značajan udio u mortalitetu čine donori organa kojih je tijekom 2018. godine bilo 22, a imali su sterilne hemokulture. Zaključak: U JIL-u KBC-a Osijek nije zabilježena statistički značajna razlika u smrtnosti kod pacijenata kojima tijekom njihovog boravka nije izoliran nijedan patogeni uzročnik, u odnosu na pacijente kojima je izolirana patogena bakterija iz krvi.Objectives: The aim of this study is to identify pathogenic microorganisms in blood culture samples, examine their sensitivity to antibiotics and compare the isolated microorganisms with the final status and outcome of the patients. Study Design: cross-sectional study Material and methods: 123 patients admitted to the ICU from January 2018 to December 2018 were included in this study. Disease history, therapeutic list and in total 482 blood culture samples were analyzed. Pathogenic microorganisms isolated in blood culture samples were identified and antibiotic sensitivity of the most commonly isolated bacteria was described. Antibiotic therapy on the day of blood culture sampling was compared to the therapy administered when the results of positive blood cultures came in. Statistical analysis was performed using t-test, χ2 test, Fisher's exact test, Mann-Whitney test and Pearson's correlation. Results: Arithmetic median age of patients was 63 years. 33 out of 123 patients (27 %) had positive blood culture results. The most frequent pathogenic microorganisms isolated in blood culture samples were gram positive bacteria, and the most frequently isolated one was MR-CNoS. Most common antibiotics introduced in patients’ therapy were meropenem, metronidazole, vancomycin and colistin. Longer duration of stay also meant a higher number of antibiotics used for the patient (r = 0,296; P = 0,002). On the day of the positive blood culture sampling colistin and cloxacillin were the most used antibiotics, while meropenem was the most common one used after the arrival of the positive blood culture results. A total of 48 patients (39 %) died, 10 of which had one or more positive blood culture samples. 22 organ donors, all of whom had negative blood culture results, contributed to the significant share of mortality. Conclusion: No statistical singificance was recorded in mortality between the patients who had negative blood culture results and those who had positive blood culture results in The Osijek Clinical Hospital Centre's ICU