The fight against gram-negative superbugs in the intensive care units

Abstract

AIM: To determine the factors affecting mortality in patients with gram-negative bloodstream infections (GNBSI) in intensive care units (ICU). BACKGROUND: Mortality and morbidity from GNBSI are high due to the increasing antimicrobial resistance of gram-negative patogens and the limited access to available antibiotics. A comprehensive understanding of the associated factors is therefore essential to reduce mortality. METHODS: The study was conducted retrospectively in Akdeniz University Hospital, Turkiye, between January 2020 and December 2022. RESULTS: Data from 202 patients with GNBSI in the ICU were analysed. Of the patients 65.8% were male. Of the patients 70.7% died. Mortality rates were lower in ICU admissions due to neurological disease and trauma (p=0.001), in those who had a tracheostomy (p=0,001) and were fed with a percutaneous endoscopic gastrostomy (p=0,025). Mortality rates were higher in patients in isolated rooms (p=0.003). The analysis indicated that older age (p=0.01), concomitant pulmonary diseases (p<0.001), neutropenia (p<0.001), abdominal surgery (p=0.025) and previous antibiotic use (p=0.022) were associated mortality. A total of 250 organisms were identified in the blood cultures. The most common bacteria were Klebsiella pneumoniae (n=112, 44.8%) and Acinetobacter species (n=83, 33.2%). Of all isolates 85.2% were multidrug resistant. Carbapenem resistance was higher in non-survivors (p<0.001). The C-reactive protein/albumin ratio calculated on admission was higher in those who died (p=0,004). CONCLUSIONS: In this specific patient group, it is of the paramount importance to identify predisposing factors, administer an appropriate antibiotic and provide supportive therapies in order to reduce mortality.

Keywords

• Gram negative bacteria
• bloodstream infections
• mortality