The use of empirical antibiotics in intensive care unit and relationship between nutrition and the incidence of infection

Year 2019, Volume: 46 Issue: 3, 489 - 498, 16.09.2019

Salih Yıldırım Yavuz Orak Rukiye Menemencioğlu Ahmet Altun Filiz Orak Cevdet Düger Esra Özpay Fatih Mehmet Yazar

https://doi.org/10.5798/dicletip.620514

Abstract

Objective: Aim of study is to determine which antibiotic is started empirically in the ICU and to investigate whether the antibiotic started according to culture result was changed or not and the effect of this change on mortality, and to investigate the relationship between mortality and infection by determining whether enteral and parenterally fed patients have attained sufficient calorie level.

Method: After the approval of the local ethics committee, the files of 476 patients hospitalized in our hospital were retrospectively reviewed. A total of 159 patients over 18 years of age who received mechanical ventilation therapy for at least 3 days were included in the study. Blood, urine and tracheal aspirate culture were determined. It was recorded whether antibiotics had changed according to the culture result. Nutritional patterns, number of feeding days and basal caloric need were determined. It was investigated whether basal calorie need was met on 1, 3 and 5 days. Factors affecting mortality were investigated.

Results: Antibiotic exchange was significantly higher in the patients who died (P = 0.002). Mortality was higher in patients who were unable to reach the target calorie (P = 0.01). Empirical changes in antibiotics (r: 0.174, P = 0.028), and culture positivity (r: 0.177, P = 0.026) were associated with mortality (r: 0.195, P = 0.014). In the subgroup analysis, reproduction in tracheal aspirate culture was an important factor affecting mortality (r: 0.211 P: 0.008).

Conclusions: The number of days of hospitalization, antibiotic change, culture positivity and inability to reach the target calories in nutrition are associated with mortality in the intensive care unit.

Keywords

empirical antibiotic therapy, mortality, intensive care unit

References

• 1. Patel A, Laffan MA, Waheed U, Brett SJ. Randomised trials of human albumin for adults with sepsis: systematic review and meta-analysis with trial sequential analysis of all-cause mortality. BMJ. 2014;349:g4561.
• 2. Yin M, Si L, Qin W, et all. Predictive Value of Serum Albumin Level for the Prognosis of Severe Sepsis Without Exogenous Human Albumin Administration: A Prospective Cohort Study. J Intensive Care Med. 2018 Dec; 33: 687-94.
• 3. Kim H, Hur M, Moon HW, Yun YM, Di Somma S. Multi-marker approach using procalcitonin, presepsin, galectin-3, and soluble suppression of tumorigenicity 2 for the prediction of mortality in sepsis. Ann Intensive Care. 2017; 7:27.
• 4. Kumar A, Roberts D, Wood KE et all. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006; 34: 1589–96.
• 5. Cooke J, Alexander K, Charani E, et all. Antimicrobial stewardship: an evidence-based, antimicrobial self assessment toolkit (ASAT) for acute hospitals. J Antimicrob Chemother. 2010 Dec; 65: 2669-73.
• 6. Heyland DK, Dhaliwal R, Drover JW, et all. Canadian Critical Care Clinical Practice Guidelines Committee. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr 2003;27: 355-73.
• 7. Corona A, Bertolini G, Lipman J, Wilson AP, Singer M. Antibiotic use and impact on outcome from bacteraemic critical illness: the Bacteraemia Study in Intensive Care (BASIC). J Antimicrob Chemother 2010;65:1276–85.
• 8. Pouwels KB, Van Kleef E, Vansteelandt S, et all. Does appropriate empiric antibiotic therapy modify intensive care unit-acquired Enterobacteriaceae bacteraemia mortality and discharge? J Hosp Infect. 2017; 96: 23-8.
• 9. J. M Fitzpatrick, J. S. Biswas, J. D. Edgeworth, et all, on behalf of the United Kingdom Clinical Infection Research Group. Gram-negative bacteraemia; a multi-centre prospective evaluation of empiric antibiotic therapy and outcome in English acute hospitals. ClinMicrobiol Infect. 2016; 22:244-51.
• 10. Harbarth S, Garbino J, Pugin J, et all. Inappropriate initial antimicrobial therapy and its effectonsurvival in a clinical trial of immunomodulating therapy for severe sepsis. Am J Med 2003;115:529–35.
• 11. Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 2000;118:146–55.
• 12. Kollef MH, Sherman G, Ward S, Fraser VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 1999;115:462–74.
• 13. Kumar A, Roberts D, Wood KE, et all. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006;34:1589–96.
• 14. Luna CM, Niederman MS, Vay C, et all. Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest 1997;111: 676- 85.
• 15. Dirk Vogelaers, David De Bels, Frédéric Forêt, et all. For the ANTHICUS Study Investigators. Patterns of antimicrobial therapy in severe nosocomial infections: empiric choices, proportion of appropriate therapy, and adaptation rates. amulticentre, observational survey in critically ill patients. International Journal of Antimicrobial Agents 2010; 375–81.
• 16. Colardyn F, Edwards JR. The role of carbapenems in difficultto- treat infections in the ICU. Clin Intensive Care 1996; 7: 19-24.
• 17. Alvarez-Lerma F, Serious Infection Study Group. Efficacy of meropenem as monotherapy in the treatment of ventilator associated pneumonia. J Chemother 2001;13: 70- 81.
• 18. Garau J, Blanquer J, Cobo L, et all. Prospective, randomised, multicentre study of meropenem versus imipenem/ cilastatin as empiric monotherapy in severe nosocomial Infections. Eur. J. Clin. Microbiol. Infect. Dis. 1997:16: 789-96.
• 19. Chakravarty C, Hazarika B, Goswami L, Ramasubban S. Prevalence of malnutrition in a tertiary care hospital in India. Indian J Crit Care Med. 2013;17: 170–3.
• 20. Mendes R, Policarpo S, Fortuna P, et all. Portuguese NUTRIC Study Group. Nutritional risk assessment and cultural validation of the modified NUTRIC score in critically ill patients – A multicenter prospective cohort study. J Crit Care. 2017;37: 249.
• 21. Kalaiselvan MS, Renuka MK, Arunkumar AS. Use of Nutrition Risk in Critically ill (NUTRIC) Score to Assess Nutritional Risk in Mechanically Ventilated Patients: A Prospective Observational Study. Indian Journal of Critical Care Medicine 2017; 21: 253-6.
• 22. Bhullar HS1, Shaikh FA, Deepak R, Poddutoor PK, Chirla D. Antimicrobial Justification form for Restricting Antibiotic Use in a Pediatric Intensive Care Unit. Indian Pediatr 2016; 53:304-6.
• 23. Blot S. Limiting the attributable mortality of nosocomial infection and multidrug resistance in intensive care units. Clin Microbiol Infect 2008;14: 5–13.
• 24. S.A. McClave, R.G. Martindale, V.W. Vanek, et all. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient. Society of critical care medicine (SCCM) and American society for parenteral andenteral nutrition (A.S.P.E.N), Journal of Parenteral and Enteral Nutrition 2016 Feb; 40: 159-211.
• 25. Heidegger CP, Darmon P, Pichard C: Enteral vs. parenteral nutrition for the critically ill patient: a combined support should be preferred. Curr Opin Crit Care 2008; 14: 408–14.
• 26. Gerlach AT, Murphy C.An update on nutrition support in the critically ill. J Pharm Pract 2011; 24: 70–7.
• 27. Doig GS, Heighes PT, Simpson F, Sweetman EA, Davies AR. Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta-analysis of randomised controlled trials. Intensive Care Med. 2009; 35:2018-27.
• 28. Woodcock NP, Zeigler D, Palmer MD, Buckley P, Mitchell CJ, Mac Fie J. Enteral versus parenteral nutrition: a pragmatic study. Nutrition. 2001; 17: 1-12.
• 29. Altintas ND, Aydin K, Turkoglu MA, Abbasoglu O, Topeli A. Effect of enteral versus parenteral nutrition on outcome of medical patients requiring mechanical ventilation. Nutr Clin Pract. 2011; 26: 322-9.
• 30. Harvey SE, Parrott F, Harrison DA, et all. CALORIES Trial Investigators. Trial of the route of early nutritional support in critically ill adults. N Engl J Med. 2014; 371: 1673-84.