Yoğun Bakım Ünitesindeki Bakteriyemik Hastalarda Antibiyotik Direncinin ve Uygunsuz Ampirik Antibiyotik Tedavisinin 3 Günlük ve 28 Günlük Mortalite Üzerine Etkisi: 5 Yıllık Retrospektif Analiz

Abstract

Amaç: Bu çalışmanın amacı, kan dolaşımı enfeksiyonu tanılı hastalarda antibiyotik direnci, ampirik antibiyotik tedavisi ve komorbid hastalıkların 3 günlük ve 28 günlük mortalite üzerine etkisinin incelenmesidir. Gereç ve Yöntemler: 1 Ocak 2015 ile 1 Ocak 2020 tarihleri arasında pozitif kan kültürü sonucu olan hastaların dosyaları geriye dönük olarak analiz edildi. Birincil sonlanım noktası 3 günlük mortalite ve ikincil sonlanım noktası 28 günlük mortalite idi. Bulgular: Çalışmaya, 208 (%40,4) kadın ve 307 (%59,6) erkek, toplam 515 hasta dahil edildi. Hastaların ortanca yaşı 73 (aralık, 18-95) yıl idi. 233 gram pozitif bakterinin 8’inde (%3,4) vankomisin direnci saptandı. 282 gram negatif bakterinin üçüncü kuşak sefalosporin, meropenem ve kolistin direnç oranları sırasıyla %72,7 (n=205), %53,2 (n=150) ve %9,9 (n=28) bulundu. 3 günlük ve 28 günlük mortalite oranları sırasıyla %14,4 (n=74) ve %64,3 (n=331) idi. Charlson komorbidite indeks skoru (Charlson comorbidity index score, CCIS) (p=0.001) ve akut fizyoloji ve kronik sağlık değerlendirmesi (acute physiology and chronic health evaluation, APACHE) skoru (p=0,019) 3 günlük mortalite için risk faktörleri olarak saptandı. 28 günlük mortalite için yaş (p<0,001), CCIS (p<0,001), APACHE II skoru (p=0,001), kronik obstrüktif akciğer hastalığı (p=0,007), hastane kaynaklı enfeksiyon (p=0,033) ve uygunsuz antibiyotik tedavisi (p<0,001) risk faktörleri idi. Sonuç: Antibiyotik direnci ile mortalite arasında bir ilişki yoktu, ancak uygunsuz antibiyotik tedavisinin 28 günlük mortalite riskini artırdığı saptandı. Ayrıca yüksek CCIS ve APACHE II skorları hem 3 günlük hem de 28 günlük mortalite riskini arttırdığı için, bu skorlama sistemlerinin dikkate alınmasının mortalite riskini azaltacağını düşünüyoruz.

Keywords

• Mortalite
• sepsis
• yoğun bakım
• bakteriyemi
• antibiyotik
• direnç

The Effect of Antibiotic Resistance and Inappropriate Empirical Antibiotic Therapy on 3-Day and 28-Day Mortality in Bacteremic Patients in the Intensive Care Unit: 5-Year Retrospective Analysis

Abstract

Aim: The aim of this study was to examine the effects of antibiotic resistance, empirical antibiotic therapy, and comorbid diseases on 3-day and 28-day mortality in patients with bloodstream infections. Material and Methods: Files of the patients with positive blood cultures results, between January 1st, 2015, and January 1st, 2020 were analyzed retrospectively. The primary outcome was 3-day mortality and the secondary outcome was 28-day mortality. Results: A total of 515 patients, 208 (40.4%) female and 307 (59.6%) male, were included in the study. The median age of the patients was 73 (range, 18-95) years. Vancomycin resistance was detected in 8 (3.4%) of 233 gram-positive bacteria. Third-generation cephalosporin, meropenem, and colistin resistance rates of the 282 gram-negative bacteria were found to be 72.7% (n=205), 53.2% (n=150), and 9.9% (n=28), respectively. The 3-day and 28-day mortality rates were 14.4% (n=74) and 64.3% (n=331), respectively. Charlson comorbidity index score (CCIS) (p=0.001) and acute physiology and chronic health evaluation (APACHE) II score (p=0.019) were found to be risk factors for 3-day mortality. Risk factors for 28-day mortality were; age (p<0.001), CCIS (p<0.001), APACHE II score (p=0.001), chronic obstructive pulmonary disease (p=0.007), hospital-acquired infection (p=0.033), and inappropriate antibiotic therapy (p<0.001). Conclusion: There was no association between antibiotic resistance and mortality, but inappropriate antibiotic treatment was found to increase the risk of 28-day mortality. In addition, since high CCIS and APACHE II scores increase the risk of both 3-day and 28-day mortality, we think that considering these scoring systems will reduce the risk of mortality.

Keywords

• Mortality
• sepsis
• critical care
• bacteraemia
• antibiotic
• resistance

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