Naslov
Analysis of primary urosepsis in medical intensive care unit in University Hospital: intensive care unit survival and the effect of antimicrobial therapy

Autori
Degoricija, Vesna ; Sharma, Mirella, Legac, Ante ; Gradišer, Marina ; Šefer, Siniša ; Vučičević, Željko

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Osmi simpozij o spolno prenosivim bolestima i urogenitalnim infekcijama, simpozij Slavka Schenwalda-Knjiga sažetaka / Škerk, Višnja - Zagreb : Hrvatski liječnički zbor-Hrvatsko društvo za urogenitalne i spolno prenosive infekcije, 2006, 11-12

Skup
Osmi simpozij o spolno prenosivim bolestima i urogenitalnim infekcijama, simpozij Slavka Schenwalda

Mjesto i datum
Opatija, Hrvatska, 25.03.2006. - 28.03.2006

Vrsta sudjelovanja
Pozvano predavanje

Vrsta recenzije
Domaća recenzija

Ključne riječi
primary urosepsis ; ICU outcome ; antimicrobial therapy

Sažetak
Aim. To evaluate epidemiology of primary urosepsis in medical intensive care unit (ICU) in University Hospital, and the impact of ICU performance and adequate empirical antibiotic therapy on survival. Methods. Observational, partly prospective study conducted in medical ICU during six years assessed all patients (pts.) meeting criteria for sepsis at ICU admission. Clinical presentation of sepsis was defined according to 2001 International sepsis definitions conference. Demographic data, admission category, source of infection, severity of sepsis, ICU/hospital stay and outcome, ICU performance and appropriateness of empirical antibiotic therapy were analyzed. Results. The study included 314 (6.3%) pts, predominantly male, median age 71, 176 (56.1%) ICU survivors and 138 (43.9%) non-survivors. The non-survivors were older, with limited mobility and predominantly male (p<0.001 ; p<0.001, p=0.030) but did not differ in relation to the acquisition of sepsis. Nosocomial origin of sepsis was found in 119 (37.8%) pts. There were more septic pts in the winter (p=0.013) with higher death rate (p=0.002). Mean length of stay was 6.97+/-5.96 days for ICU, and 15.82+/-15.05 days for hospital. On day 1 mean GSC was 10.84+/-3.98, APACHE II 19.98+/-7.86, and SOFA score 5.82+/-3.35, non-survivors had significantly lower GCS and higher APACHE II and SOFA scores (p<0.001 for all), and history of chronic heart (p<0.001), and respiratory (p<0.001) failure. At the ICU admission sepsis was present in 100 (31.8%), severe sepsis in 89 (28.6%), and septic shock in 125 (39.8%) pts. Mortality rate for sepsis was 17%, severe sepsis 33.7%, septic shock 72.1% and MODS 74.4%. Microbiological documentation of sepsis was obtained in 235 (74.8%) pts ; bloodstream infection was documented in 62 (19.8%), urinary in 65 (20.7%), and respiratory tract infection in 16 (5.1%) pts ; 86 (27.4%) presented with documented infection in bloodstream and focus, and 6 (1.9%) presented with documented sepsis in two different focuses. Positive blood culture rate at admission was 49%, documented presence of bacteria in bloodstream was related to better outcome (p<0.001). Urinary tract infections were the most common 168 (53.5%), followed by skin/soft tissue 58 (18.5%), lower respiratory tract 44 (14.0%) and gallbladder/bile ducts 17 (5.4%) infections. Gram-negative sepsis was the most frequent, followed by Gram-positive and polymicrobial sepsis in bloodstream and focus documented sepsis. Escherichia coli was isolated in 107 (31.2%) cases, as the most frequent organism, followed by Pseudomonas aeruginosa in 33 (9.6%), Proteus mirabillis in 27 (7.9%), and Klebsiella pneumoniae in 20 (5.8%). Appropriateness of antibiotic treatment was evaluated in 266 pts. Empirical antibiotic treatment was considered adequate in 107 (60.5%) survivors and 42 (31.2%) non-survivors, and inadequate in 70 (39.5%) survivors and 95 (68.8%) non-survivors (p=<0.001). Patients treated with adequate empirical antibiotic therapy had significantly higher survival time in hospital (log-rank p=0.0011). Conclusion. Sepsis syndrome commonly occurs among vulnerable pts, such as elderly and pts with multiple comorbidities. ICU management and performance with fully trained specialists and residents in intensive care medicine who are able to perform early and aggressive resuscitation of septic pts, and prompt and appropriate empiric antimicrobial treatment is life saving. On the contrary, severity of illness of this group of pts was underestimated in emergency department, which resulted in poor early resuscitation treatment and time delay in ICU admission that might be fatal.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA