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P010: Bloodstream infections by drug-resistant organisms in a secondary hospital
© Gimenez-Julvez et al; licensee BioMed Central Ltd. 2013
Published: 20 June 2013
Bloodstream infections (BSI) are important causes of morbidity and mortality. Most of all, when are caused by drug-resistant organisms (DR).
To investigate the epidemiology, etiology, systemic response and treatment of DR-BSI.
A retrospective study was conducted about all BSI diagnosed in a secondary hospital during one year. The pattern resistant pathogen study was EPINE-EPPS project. Comparisons between groups were performed by means of the X2 test for categorical variables or analysis of variances (ANOVA) for continuous variables.
We included 60 patients [median and interquartile range (IQR) age, 73.5 years (60.5-79.5), 57.1% males, median (IQR) Charlson comorbidity index, 3 (2-4), median (IQR) acute physiology and chronic health evaluation (APACHE) II score, 11 (8-15)] with 63 DR-BSI of which 71.5% were nosocomial and healthcare-associated BSI.
Unknown and intravascular catheter-related DR-BSI accounted for 49.2% of cases. Among secundary infections, the source was 37.5% urinary track, 31.2% intra-abdominal and 15.6% respiratory track infections.
Overall DR-BSI, DR-Gram-positive cocci were 55.6%. The most common isolated pathogens were staphylococcus coagulase-negative and S. aureus. Among DR-Gram-negative bacilli, 12.2% of enterobacteracea family produced extended-spectrum B-lactamasas. We found 5 DR-BSI caused by Acitetobacter carbapenem resistant and 3 DR-BSI by P. aeruginosa carbapenem resistant.
Median time to diagnosis for DR-Nosocomial BSI was 14 days (IQR), 7-35 days after hospital admission. For Gram-negative was 11 days (7.5-31.5) and for Gram-positive 19 days (7-29).
Only 31.7% of DR-BSI received appropriate initial empirical antimicrobial therapy versus 73.5% of non DR-BSI (p<0.001). More than one third (36.5%) of the episodes occur with significant systemic response (severe sepsis or septic shock). The crude mortality rate was 25.4 % (p<0.001). If the patient developed severe sepsis or septic shock crude mortality rose to 52.2%.
Information about local epidemiology is important to develop prevention and control strategies in drug–resistant microorganism and to improve the management of BSI.
Disclosure of interest
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.