Microbiological and Clinical Characteristics of Bloodstream Infections in General Intensive Care Unit: A Retrospective Study

• Published in: Frontiers in medicine 2022-04, Vol.9, p.876207-876207
• Main Authors: Wu, He-Ning, Yuan, Er-Yan, Li, Wen-Bin, Peng, Min, Zhang, Qing-Yu, Xie, Ke-Liang
• Format: Article
• Language: English
• Subjects: antibiotic resistance; bloodstream infection; Medicine; multidrug-resistance; procalcitonin; vancomycin-resistant enterococci (VRE)
• ISSN: 2296-858X; 2296-858X
• DOI: 10.3389/fmed.2022.876207

Bloodstream infections (BSI) are one of the common causes of morbidity and mortality in hospitals; however, the pathogenic spectrum and bacterial antibiotic resistance vary across the world. Therefore, identifying the pathogenic spectrum and changes in bacterial antibiotic resistance is critical in controlling BSI and preventing the irrational use of antibiotics. This study evaluated the microbiological and clinical data of BSI patients in the intensive care unit (ICU) of Tianjin Medical University General Hospital in Tianjin, China, to guide the selection of empirical antibiotic therapy. This study retrospectively analyzed the distribution and antibiotic resistance of pathogens based on the clinical data of BSI patients presented in the ICU of a tertiary teaching hospital from 2018 to 2020. Test performance for the prediction of pathogen species was assessed by receiver operating characteristic (ROC) analysis. The analysis of the data of 382 BSI cases (10.40 cases per thousand patient day) revealed the most frequently isolated microorganisms to be (11.52%), followed by (9.95%), (9.95%), (8.12%), and (8.12%). Out of the isolated and strains, 52.63, and 36.36%, respectively, were extended-spectrum β-lactamase (ESBL) positive. The antibiotic-resistance rate of the ESBL-positive strains was 30.56% for piperacillin/tazobactam, 5.56% for imipenem, and 11.11% for tigecycline. In addition, most belonged to the group of multidrug-resistant (MDR) strains, with an antibiotic-resistance rate of 90.48% for meropenem and 16.00% for amikacin. However, polymyxin-resistant strains were not detected. Four strains of methicillin-resistant (MRSA) (4/21, 19.05%) and one strain of vancomycin-resistant enterococci (VRE) were detected, with a resistance rate of 4.76 and 2.32%, respectively. Among the isolated 55 fungal strains, was the most common one (30/55, 56.36%), with an antibiotic-resistance rate of 5.77% for voriconazole, fluconazole, and itraconazole. The presence of amphotericin B-or flucytosine-resistant strains was not observed. Compared with the patients with Gram-positive and fungal pathogens, patients with Gram-negative bacteria exhibited the highest sequential organ failure assessment (SOFA) score ( < 0.001), lowest Glasgow Coma Scale (GCS) ( = 0.010), lowest platelet (PLT) value ( < 0.001), highest plasma creatinine (Cr) value ( = 0.016), and the highest procalcitonin (PCT) value ( < 0.001). The AUC in the ROC curve was 0.698 for the differentiation of Gram-negat