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

Öz

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.

Anahtar Kelimeler

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

Anestezi Yoğun Bakım Ünitesinde Enfeksiyöz Hastalıkların Prevalansı ve Antibiyotik Kullanımının Değerlendirilmesi

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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