Epidemiologic, clinical characteristics, and risk factors for adverse outcome in multiresistant gram-negative primary bacteremia of critically ill patients - 19/08/11
, Matthew E. Falagas b, c, d, Dimitra C. Karatza a, Paraskevi Alexandropoulou a, Emmanuel Papadakis a, Leonidas Gregorakos a, George Chalevelakis d, Georgios Pappas a, e
Address correspondence to Argyris Michalopoulos, MD, Director of Intensive Care Unit, Henry Dunant Hospital, 107 Mesogeion Ave, 11526 Athens, Greece.Abstract |
Background |
Characteristics and burden of primary bacteremia because of multidrug-resistant (MDR) gram-negative bacteria (GNB) in intensive care unit (ICU) patients remain understudied.
Methods |
A cohort study of patients with primary MDR GNB-related bacteremia from the ICU of a tertiary Greek hospital during a 3-year period was conducted for recognition of clinical characteristics and risk factors for adverse outcome. A case-control study was further performed to evaluate risk factors for development of MDR GNB-related primary bacteremia.
Results |
Fifty monomicrobial episodes of primary bacteremia because of Klebsiella pneumoniae (n = 20), Acinetobacter baumannii (n = 18), and Pseudomonas aeruginosa (n = 12) were recorded. The presence of diabetes mellitus was the only significant risk factor for development of MDR GNB-related primary bacteremia. Most episodes (78%) were ICU acquired in patients with prolonged mechanical ventilation and previous hospitalization in the ward. Mortality was 47.6% vs 19% of controls, P = .01. Mortality was higher in recurrent bacteremia (62.5%). Mortality was statistically associated with age (P = .002) and degree of multiorgan dysfunction expressed by sequential organ failure assessment score on day of bacteremia documentation (P = .001).
Conclusion |
Critically ill patients with MDR GNB-related primary bacteremia present significant mortality mainly associated with age and multiorgan failure. A baumanii bacteremia confers significant mortality compared with the benign course of K pneumoniae in such settings. Diabetes mellitus is a risk factor for development of such episodes, which may, in part, be general ward acquired, underlining the need for expanded vigilance.
Le texte complet de cet article est disponible en PDF.Key Words : Primary bacteremia, gram-negative bacteremia, multiple drug resistance, intensive care unit-acquired infection, ICU-acquired infection
Plan
| Conflicts of interest: None to report. |
Vol 39 - N° 5
P. 396-400 - juin 2011 Retour au numéro
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