The Causative Agents, Their Antimicrobial Susceptibilities and Their Effects on Mortality of Intensive Care Infections in Atatürk University Medical Faculty Research Hospital

Abstract

Introduction: Hospital-acquired infections (HAIs) are one of the important mortality and morbidity reasons in patients. For this reason, recognition of infectious agents and their resistance to antimicrobials in intensive care unit (ICU) is very important for rational antibiotic use. The present study aimed to investigate the types of HAIs, causative microorganisms, resistance patterns, and risk factors, and to identify their impacts on mortality in Anesthesiology, Intensive Medicine, Neurology, General Surgery, and Orthopedics ICUs in Atatürk University, Faculty of Medicine, Research Hospital. Materials and Methods: Patients who were diagnosed as having HAI in ICUs between 1 June 2019-30 November 2019 were evaluated prospectively. Demographic data, types of grown pathogens, and resistance rates were recorded. The impact of variables on mortality was investigated. Results: One hundred and sixty five HAIs were diagnosed in 81 patients, out of 1.078 patients admitted to ICUs. The mean age of patients who developed HAI was 65.2±15.7 years, while the mean age of patients who lost their lives was 67.5±15.3 years. The mean age of the patients who died was significantly higher than the patients who were discharged (p=0.028). There was a significant relationship between risk factors including chronic obstructive pulmonary disease, congestive heart failure, mechanical ventilation, and endotracheal intubation, and mortality (p=0.047, p=0.047, p=0.04, and p=0.002, respectively). Hospital-acquired infection was found to be significantly related with mortality in ICU patients o (p<0.001). The most common types of infections were found to be catheter-related bloodstream infection (41.8%), ventilator-associated pneumonia (22.4%) and catheter-related urinary tract infection (20%). Gram-negative bacteria or agents were causative in 71.5% of HAIs, Gram-positive bacteria or agents 24.2%, and Candida spp. 4.2%. The most frequently isolated Gram-negative bacteria were Acinetobacter spp., Klebsiella pneumonia and Pseudomonas aeruginosa. In terms of antibiotic resistances, carbapenem resistance was found to be 100% in Acinetobacter spp. strains. Extended spectrum beta-lactamase was produced in 70.5% of Escherichia coli strains and 77.7% of Klebsiella pneumoniae strains. Vancomycin resistance was not found in Enterococcus. Conclusion: It is of the utmost importance for each center to monitor their own flora, causative microorganisms, and antibiotic resistances alongside with surveillance studies for the control of HAIs. This will ensure the use of suitable antibiotics in empirical treatment. It is necessary to increase compliance with infection control standards in ICUs and to avoid unnecessary invasive procedures. In this way, a decrease in HAIs that cause increased morbidity and mortality can be achieved.

Keywords

• hospital-acquired infections
• antibiotic resistances
• mortality