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

Year 2022, Volume: 24 Issue: 2, 187 - 192, 30.08.2022

İlker Ödemiş , Tuğba Arslan Gülen

https://doi.org/10.18678/dtfd.1069393

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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