Prevalence of Infectious Diseases and the Assessment of Antibiotic Use in the Anesthesia Intensive Care Unit

Year 2025, Volume: 51 Issue: 2, 311 - 318, 28.08.2025

Gökçe Kızılkale Kayıkcı , Murat Aksun , Atilla Şencan , Mensure Çakırgöz , Senem Girgin , Esin Çetingöz

https://doi.org/10.32708/uutfd.1655566

Abstract

Infections remain a major cause of morbidity and mortality in intensive care units. In this retrospective study, conducted to determine the prevalence of infections and resistance patterns in intensive care patients and to highlight the prognostic value of biomarkers and disease severity scores, 195 patients with suspected or confirmed infections admitted to the Anesthesia ICU of XXXXX Hospital between March 2020 and March 2021 were evaluated. Demographic data, infection foci, microbiological findings, biomarkers (WBC, CRP, PCT), and disease severity scores (APACHE II, SAPS II, SOFA) were analyzed. The infection prevalence was 60.6%, and ICU mortality was 49.7%. The median age was 67 years (IQR: 56–77), and 61% were male. Age, sex, and BMI were not associated with mortality. Non-survivors had significantly higher severity scores (APACHE II: 28.6 vs. 18.1; SAPS II: 63.2 vs. 41.2; SOFA: 10.8 vs. 6.4; all p<0.001). Common comorbidities included cardiovascular disease (69.2%), diabetes (21.0%), and chronic respiratory disease (19.5%). Respiratory (36.0%), intra-abdominal (18.0%), and bloodstream infections (17.4%) were most common. Tracheal aspirates were the most frequent culture-positive samples (35.3%). K. pneumoniae, A. baumannii, and E. coli were the predominant pathogens. Antimicrobial resistance was found in 56.0% of culture-positive cases, without a significant mortality association (p=0.118). Empirical antimicrobial therapy was initiated in 87.7% of patients. By the 72nd hour of treatment, significant reductions were observed in PCT (1.4→0.9 ng/mL, p<0.001) and WBC (15.3→12.4×10³/μL, p<0.001) levels, while the change in CRP was not statistically significant (p=0.181). In the mortality group, initial CRP (111.0 vs. 78.5 mg/L, p=0.032) and PCT (2.4 vs. 1.0 ng/mL, p=0.034) levels were higher, whereas WBC did not differ significantly (p=0.787). Our findings suggest that severity scores and biomarker changes have prognostic value in infected critically ill patients, and integrating host response with microbiological data may aid clinical management.

Keywords

ICU infections , antimicrobial resistance , biomarkers , empirical antibiotics , mortality

Anestezi Yoğun Bakım Ünitesinde Enfeksiyöz Hastalıkların Prevalansı ve Antibiyotik Kullanımının Değerlendirilmesi

Abstract

Enfeksiyonlar, yoğun bakım ünitelerinde morbidite ve mortalitenin başlıca nedenlerindendir. Yoğun bakım hastalarında enfeksiyonların yaygınlığını ve direnç paternlerini ortaya çıkararak, biyobelirteçler ile hastalık şiddeti skorlarının prognozdaki önemini vurgulamayı amaçladığımız bu retrospektif çalışmada; Mart 2020–Mart 2021 tarihleri arasında XXXXX Hastanesi Anestezi YBÜ’nde şüpheli veya doğrulanmış enfeksiyon tanısı ile izlenen 195 hasta değerlendirildi. Demografik veriler, enfeksiyon odakları, mikrobiyolojik bulgular, biyobelirteçler (WBC, CRP, PCT) ve hastalık şiddeti skorları (APACHE II, SAPS II, SOFA) analiz edildi. Enfeksiyon prevalansı %60,6; mortalite oranı %49,7 olarak bulundu. Medyan yaş 67,0 yıl (IQR: 56,0-77,0) olup hastaların %61,0'ı erkekti. Yaş, cinsiyet ve vücut kitle indeksi mortalite ile ilişkili bulunmadı. Mortalite grubunda APACHE II (28,6 vs. 18,1), SAPS II (63,2 vs. 41,2) ve SOFA (10,8 vs. 6,4) skorları anlamlı olarak daha yüksekti (tüm skorlar için p <0,001). Kardiyovasküler hastalıklar (%69,2), diyabet (%21,0) ve kronik solunum yolu hastalıkları (%19,5) en yaygın komorbiditelerdi. En yaygın enfeksiyon odakları solunum sistemi (%36,0), intraabdominal (%18,0) ve kan dolaşım sistemi (%17,4) olarak belirlendi. Toplam 133 kültür pozitif örnek arasında en sık üreme, (n=47, %35,3) trakeal aspirat kültürlerinde saptandı. İzole edilen patojenler arasında en sık K. pneumoniae, A. baumannii ve E. coli görüldü. Kültür pozitif vakaların %56,0’sında antimikrobiyal direnç mevcut olup, mortaliteyle istatistiksel olarak ilişkilendirilmedi (p=0,118). Hastaların %87,7’sine ampirik antimikrobiyal tedavi başlandı. Antimikrobiyal tedavinin 72. saatinde PCT (1,4→0.9 ng/mL, p<0,001) ve WBC (15,3→12,4 ×10³/μL, p<0,001) düzeylerinde anlamlı düşüş izlenirken, CRP değişimi anlamlı değildi (p=0,181). Mortalite grubunda başlangıç CRP (111,0 vs. 78,5 mg/L, p=0,032) ve PCT (2,4 vs. 1,0 ng/mL p=0,034) düzeyleri daha yüksekken, WBC de anlamlı fark saptanmadı (p=0,787). Bulgularımız, enfeksiyonu olan kritik hastalarda hastalık şiddeti skorları ve biyobelirteç değişimlerinin prognostik değerini ortaya koymakta; konak yanıtı ile mikrobiyolojik verilerin birlikte değerlendirilmesi, hasta yönetimini kolaylaştırabilir.

Keywords

Yoğun bakım enfeksiyonları , antimikrobiyal direnç , biyomarkerler , ampirik antibiyotikler , mortalite

References

• 1. Vincent JL, Sakr Y, Singer M, et al. Prevalence and outcomes of infection among patients in intensive care units in 2017. JAMA. 2020;323(15):1478-1487. doi:10.1001/jama.2020.2717
• 2. Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant, and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268-281. doi:10.1111/j.1469-0691.2011.03570.x
• 3. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589-1596. doi:10.1097/01.CCM.0000217961.75225.E9
• 4. Magrini L, Gagliano G, Travaglino F, et al. Comparison between white blood cell count, procalcitonin, and C-reactive protein as diagnostic and prognostic biomarkers of infection or sepsis in patients presenting to the emergency department. Clin Chem Lab Med. 2014;52(10):1465-1472. doi:10.1515/cclm-2014-0210
• 5. Versporten A, Zarb P, Caniaux I, et al. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey. Lancet Glob Health. 2018;6(6):e619-e629. doi:10.1016/S2214-109X(18)30186-4
• 6. Centers for Disease Control and Prevention (CDC). Antibiotic resistance threats in the United States, 2019. Atlanta, GA: US Department of Health and Human Services; 2019. https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf
• 7. World Health Organization (WHO). Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. WHO Technical Report Series No. 894. Geneva: World Health Organization; 2000. https://iris.who.int/handle/10665/42330
• 8. Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis. Crit Care Med. 2006;34(1):15-21. doi:10.1097/01.CCM.0000194535.82812.BA
• 9. Flaatten H. The impact of age in intensive care. Acta Anaesthesiol Scand. 2014;58(1):3-4. doi:10.1111/aas.12221
• 10. Papathanassoglou E, Middleton N, Benbenishty J, et al. Systematic review of gender- dependent outcomes in sepsis. Nurs Crit Care. 2017;22(5):284-292. doi:10.1111/nicc.12280
• 11. Pepper DJ, Demirkale CY, Sun J, et al. Does Obesity Protect Against Death in Sepsis? A Retrospective Cohort Study of 55,038 Adult Patients. Crit Care Med. 2019;47(5):643-650. doi:10.1097/CCM.0000000000003692
• 12. Nie W, Zhang Y, Jee SH, Jung KJ, Li B, Xiu Q. Obesity survival paradox in pneumonia: a meta-analysis. BMC Med. 2014;12:61. doi:10.1186/1741-7015-12-61
• 13. Gagneja D, Goel N, Aggarwal R, Chaudhary U. Changing trend of antimicrobial resistance among gram-negative bacilli isolated from lower respiratory tract of ICU patients: a 5-year study. Indian J Crit Care Med. 2011;15(3):164-167. doi:10.4103/0972-5229.84900
• 14. Vincent JL, Rello J, Marshall J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302(21):2323-2329. doi:10.1001/jama.2009.1754
• 15. Vincent JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006;34(2):344-353.doi:10.1097/01.CCM.0000194725.48928.3A
• 16. European Centre for Disease Prevention and Control (ECDC). Surveillance of antimicrobial resistance in Europe 2023–2022 data. Stockholm: ECDC; 2023. https://www.ecdc.europa.eu/en/publications-data/surveillance-antimicrobial-resistance-europe-2023-2022-data
• 17. World Health Organization (WHO). Global antimicrobial resistance and use surveillance system (GLASS) report: 2022. Geneva: World Health Organization; 2022. https://www.who.int/publications/i/item/9789240062702
• 18. Maskarinec SA, Park LP, Ruffin F, et al. Positive follow-up blood cultures identify high mortality risk among patients with Gram-negative bacteraemia. Clin Microbiol Infect. 2020;26(7):904-910. doi:10.1016/j.cmi.2020.01.025
• 19. Hariyanto H, Yahya CQ, Cucunawangsih C, Pertiwi CLP. Antimicrobial resistance and mortality. Afr J Infect Dis. 2022;16(2):13–20. doi:10.21010/Ajid.v16i2.2
• 20. Phua J, Ngerng W, See K, et al. Characteristics and outcomes of culture-negative versus culture-positive severe sepsis. Crit Care. 2013;17(5):R202. doi:10.1186/cc12896
• 21. Cosgrove SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis. 2006;42(Suppl 2):S82-S89. doi:10.1086/499406
• 22. Lam SW, Bauer SR, Fowler R, Duggal A. Systematic review and meta-analysis of procalcitonin-guidance versus usual care for antimicrobial management in critically ill patients: focus on subgroups based on antibiotic initiation, cessation, or mixed strategies. Crit Care Med. 2018;46(5):684-690. doi:10.1097/CCM.0000000000002953
• 23. Suberviola B, Castellanos-Ortega A, González-Castro A, et al. Prognostic value of procalcitonin, C-reactive protein and leukocytes in septic shock. Med Intensiva. 2012;36(3):177-184. doi:10.1016/j.medin.2011.09.008
• 24. Schuetz P, Maurer P, Punjabi V, et al. Procalcitonin decrease over 72 hours in US critical care units predicts fatal outcome in sepsis patients. Crit Care. 2013;17:R115. doi:10.1186/cc12787
• 25. von Dach E, Albrich WC, Brunel AS, et al. Effect of C-reactive protein-guided antibiotic treatment duration, 7-day treatment, or 14-day treatment on 30-day clinical failure rate in patients with uncomplicated gram-negative bacteremia: a randomized clinical trial. JAMA. 2020;323(21):2160-2169. doi:10.1001/jama.2020.6348