Antimicrobial treatment among critically ill patients: prospective observational single centre study

Details

Supervisors

Robert, Annie

Faculty

Faculté de santé publique

Degree label

Master [120] en sciences de la santé publique

Abstract

BACKGROUND: The prevalence of antimicrobial resistance is increasing. Adequate antimicrobial treatment ensuring the prevention of infection complications is crucial for critically ill patients. METHODS: During 3 months, a prospective observational study was conducted in a university-affiliated teaching hospital of Brussels. The objective was to evaluate the relationship between inadequate antimicrobial treatment of infections and 30-day hospital mortality after ICU admission. RESULTS: A total of 151 patients with infection while in the ICU were included in the study. There were 53 (35.1%) patients who had at least one episode of inadequate antimicrobial treatment. Positive microbiological isolates were present in 112 (74.2%) patients and most of them were Gram-negative bacteria. Combinations of penicillins with β-lactamase inhibitors were the most frequently antimicrobials used. Highest SOFA score during ICU first week showed a statistically difference between groups: patients exposed to inadequate antimicrobial treatment were more likely to have SOFA score ≥ 7 when compared to the other patients (73.6% vs. 52.0%, p=0.010). Patients with inadequate antimicrobial treatment were also statistically more likely to undergo mechanical ventilation (69.8% vs. 36.7%, p<0.001), central vein catheterization (92.5% vs. 67.3%, p=0.001), nasogastric intubation (84.9% vs. 44.9%, p<0.001) and urinary tract catheterization (100% vs. 83.7%, p=0.002). The median ICU length of stay was higher in the inadequate antimicrobial treatment group (7.4 vs. 4.8 days, p=0.001). The 30-day hospital mortality after ICU admission occurred in 40 (26.5%) patients. The occurrence of this outcome was higher in the inadequate antimicrobial treatment group (32.1% vs. 23.5%, p=0.25). Multiple logistic regression demonstrated that inadequate antimicrobial treatment was not significantly associated with 30-day hospital mortality (OR=2.61; 95% CI, 0.71 to 9.68; p=0.15). However, the impact of inadequate antimicrobial treatment on 30-day hospital mortality was significant among the subgroup of patients with APACHE II score <25 (OR=3.49; 95% CI, 1.12 to 10.90; p=0.032). Chronic arterial hypertension, APACHE II score, SOFA score and type of infection (CAI, HCAI or ICU-acquired) were identified as independent variables associated with 30-day hospital mortality after ICU admission. CONCLUSIONS: Inadequate antimicrobial treatment should not be a negligible phenomenon. Particular attention must be paid to patients with APACHE II score <25, since the impact of inadequate antimicrobial treatment on 30-day hospital mortality after ICU admission was significant among this subgroup of patients.