The Retrospective Clinical Study Of Adult Bloodstream Infection In ICU

Objective: To analyze the clinical characteristics,pathogenic characteristics,risk factors associated with death of patients with bloodstream infection in ICU and clinical characteristics,etiology distribution and susceptibility of patients with Gram-negative bacterial bloodstream infection in ICU of the Sixth People’s Hospital affiliated to Shanghai Jiao tong University is to provide a basis for clinical assessment and antibiotic treatment.Methods: These are two observational and retrospective studies about ICU adult bloodstream infection and ICU adult Gram-negative bacterial bloodstream infection to analyze clinical,laboratory,and pathogenic data in our hospital from January 1,2011 to December 31,2016.Patients with adult bloodstream infection in ICU were divided into survival group and death group according to their prognosis.Univariate analysis of risk factors for death of bloodstream infection was performed,and statistically significant variables in univariate analysis were used for logistic binary regression analysis to identify independent death risk factors for patients with bloodstream infection.Kaplan-Meier survival analysis and Log Rank test were used to compare the survival curves between groups.The difference was considered statistically significant at P<0.05.For patients with adult Gram-negative bacterial bloodstream infection in ICU,compared with patients of non-Gram-negative bacterial bloodstream infection in ICU,univariate analysis of statistically significant variables were performed for logistic binary regression analysis to identify independent risk factors of Gram-negative bacterial bloodstream infection.Statistical analysis was performed using SPSS 21.0 software.Results: A total of 371 adult patients with bloodstream infection in ICU were included in the study over the past 6 years,of which 120 died,with a total mortality rate of 32.3%.The pathogenic microorganisms isolated and cultured: 212 strains of Gram-positive bacteria,accounting for 57.4%.There were 151 strains of Gram-negative bacteria,accounting for 40.8%,and 8 strains of fungi,accounting for 2.2%.The most common pathogens were Staphylococcus epidermidis(59 strains,accounting for 15.9%),Escherichia coli(54 strains,accounting for 14.6%),Klebsiella pneumoniae(39 strains,accounting for 10.5%),and Staphylococcus aureus(37 strains,accounting for 9.9%)and Staphylococcus hominis(27 strains,accounting for 7.3%).The most common pathogen in fungal bloodstream infection is Candida albicans(6 strains,accounting for 1.6%).Basic information of 371 patients: There are 191 elderly patients aged ≥65 years old,accounting for 51.5%.58 patients(15.6%)had diabetes,74 patients(19.9%)had heart disease,105 patients(28.3%)had stroke,71 patients(19.1%)had tumor,and 102 patients(27.5%)had stage 3 and higher chronic kidney disease.265 patients(71.4%)had hypoproteinemia,and 116 patients(31.3%)had moderate above anemia.14 patients(3.8%)had a history of immunosuppressive use in the past 30 days,364 patients(98.1%)had a history of broad-spectrum antibiotic use in the past 30 days,and 165 patients(44.5%)had a history of deep venous catheterization in the past 30 days.211 patients(56.9%)had a history of mechanical ventilation in the past 30 days,317 patients(85.4%)had a history of indwelling catheterization in the past 30 days,and 16 patients(4.3%)had a history of bedside hemodialysis in the past 30 days.Multivariate regression analysis showed that age ≥ 65 years,stroke,stage 3 and higher chronic kidney disease,tumor,and mechanical ventilation were independent risk factors for death of adult patients with bloodstream infection in ICU.In the past 6 years,a total of 151 patients of adult Gram-negative bacterial bloodstream infection in ICU were included in the study.We isolated and cultured 151 strains of Gram-negative bacteria.The most common pathogens were: Escherichia coli(54 strains,accounting for 35.8%),Klebsiella pneumoniae(39 strains,accounting for 25.8%),Acinetobacter baumannii(18 strains,accounting for 11.9%),and Pseudomonas aeruginosa(16 strains,accounting for 10.6%)and Enterobacter cloacae(9 strains,accounting for 6.0%).The basic information of 151 patients: 90 patients aged 65 years or older,accounting for 59.6%,30 patients(19.9%)had heart disease,54 patients(35.8%)had stage 3 and higher chronic kidney disease,33 patients(21.9%)had diabetes,and 30 patients(19.9%)had tumor,50 Patients(33.1%)had moderate above anemia and 113 patients(74.8%)had hypoproteinemia.12 patients(7.9%)had a history of bedside hemodialysis in the past 30 days,65 patients(43.0%)had a history of deep venous catheterization in the past 30 days,and 126 patients(83.4%)had a history of indwelling catheterization in the past 30 days.98 patients(64.9%)had a history of surgery or trauma history in the past 30 days,4 patients(2.6%)had a history of immunosuppressive use in the past 30 days,and 149 patients(98.7%)had a history of broad-spectrum antibiotics in the past 30 days.Compared with the non-Gram-negative bacterial bloodstream infection group,multivariate analysis showed that age ≥65 years,diabetes,and continue blood purification were independent risk factors for the bloodstream infection group of Gram-negative bacteria in ICU.Conclusions: The mortality rate of 371 adults with bloodstream infection in ICU was 32.3%.The most common pathogens were Staphylococcus epidermidis and Escherichia coli.Multivariate analysis showed that age ≥ 65 years,stroke,stage 3 and higher chronic kidney disease,tumor,and mechanical ventilation can increase the death risk of patients with adult bloodstream infection in ICU.The most common pathogens of adult Gram-negative bacterial bloodstream infection in ICU were Escherichia coli and Klebsiella pneumoniae,Multivariate analysis showed that age ≥ 65 years,diabetes,and continue blood purification were independent risk factors for patients with Gram-negative bacterial bloodstream infection in ICU.