Evaluation of Treatment Responses and Failures of Intensive Care Unit Acquired Blood Stream Infections

摘要

Blood Stream Infections (BSI) are the second or the third most common infections acquired in Intensive Care Units (ICU) following pulmonary infections. Risk factors likely to affect response to treatment in BSI?s have been investigated in several studies. However, there have not been any studies in which the predictors of treatment failures have been evaluated to this extent.Aim: To investigate the treatment response of patients admitted to the ICU with acquired BSI cases and the predictors of treatment failures.Materials and Methods: The study was based on a cohort study design in which data were collected from all patients with admission to ICU >48 hours during one year. According to the resolution of signs and symptoms of infection, treatment outcomes (n=70) were stratified into two cohorts: 1) successful (n=20); and 2) failure (n=50) treatment. Following risk factors affecting the responses were recorded: source and severity of bacteraemia; Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores; isolated pathogens and resistance profile; appropriate antibiotic initiation; and catheter removal time. Fisher exact tests, contingency coefficients, t-tests, Mann-Whitney-U-test and logistic regression analysis was used to examine risk factors associated with treatment failure predictors.Results: The high levels of APACHE II detected on the third day of the treatment (OR=1.151) and delayed appropriate treatment with respect to the onset of bacteraemia (OR=1.532) were independent risk factors for treatment failure. The subgroup analyses revealed that other concomitant infections (78%) and superinfection (40%) were the most frequent reasons in the treatment failures.Conclusion: Delayed appropriate treatment was found to be the most crucial independent reason for treatment failure. Besides, other concomitant infections and superinfection are mostly observed other significant reasons for treatment failure.