Djuric Olivera, Markovic-Denic Ljiljana, Jovanovic Bojan, Jovanovic Snezana, Marusic Vuk, Bumbasirevic Vesna
University of Belgrade, Belgrade, Serbia.
Clinical Centre of Serbia, Belgrade, Serbia.
J Infect Dev Ctries. 2018 Dec 31;12(12):1079-1087. doi: 10.3855/jidc.10737.
We aimed to describe incidence, outcomes and antimicrobial resistance markers of causative agents of bacterial BSI in the intensive care unit (ICU) in a trauma center in Serbia.
Prospective surveillance was conducted from November 2014 to April 2016 in two trauma-surgical ICUs of the Emergency Department of Clinical center of Serbia. Bloodstream infections were diagnosed using the definitions of Center for Disease Control and Prevention.
Out of 406 trauma patients, 57 had at least one episode of BSI (cumulative incidence 14.0%). Overall 62 BSI episodes were diagnosed (incidence rate 11.8/1000 patient/days), of which 43 (69.4%) were primary BSI (13 catheter-related BSI and 30 of unknown origin) and 19 (30.6%) were secondary BSI. The most common isolated pathogen was Acinetobacter spp. [n = 24 (34.8%)], followed by Klebsiella spp. [n = 17 (24.6%)] and P. aeruginosa [n = 8 (1.6%)]. All S. aureus [n = 6 (100%)] and CoNS [n = 3 (100%)] isolates were methicillin resistant, while 4 (66%) of Enterococci isolates were vacomycin resistant. All isolates of Enterobacteriaceae were resistant to third-generation cephalosporins [n = 22 (100%)] while 7 (87.5%) of P. aeruginosa and 23 (95.8%) of Acinetobacter spp. isolates were resistant to carbapenems. All-cause mortality and sepsis were significantly higher in trauma patients with BSI compared to those without BSI (P < 0.001 each).
BSI is a common healthcare-associated infection in trauma ICU and it is associated with worse outcome. Better adherence to infection control measures and guidelines for prevention of primary BSI must be achieved.
我们旨在描述塞尔维亚一家创伤中心重症监护病房（ICU）中细菌性血流感染（BSI）病原体的发病率、结局及抗菌药物耐药标志物。
2014年11月至2016年4月在塞尔维亚临床中心急诊科的两个创伤外科ICU进行前瞻性监测。血流感染依据疾病控制与预防中心的定义进行诊断。
406例创伤患者中，57例至少发生过一次BSI（累积发病率14.0%）。共诊断出62次BSI发作（发病率为11.8/1000患者/日），其中43次（69.4%）为原发性BSI（13次与导管相关的BSI及30次来源不明），19次（30.6%）为继发性BSI。最常分离出的病原体是不动杆菌属[n = 24（34.8%）]，其次是克雷伯菌属[n = 17（24.6%）]和铜绿假单胞菌[n = 8（1.6%）]。所有金黄色葡萄球菌[n = 6（100%）]和凝固酶阴性葡萄球菌[n = 3（100%）]分离株均对甲氧西林耐药，而4例（66%）肠球菌分离株对万古霉素耐药。所有肠杆菌科分离株均对第三代头孢菌素耐药[n = 22（100%）]，而7例（87.5%）铜绿假单胞菌和23例（95.8%）不动杆菌属分离株对碳青霉烯类耐药。与未发生BSI的创伤患者相比，发生BSI的创伤患者全因死亡率和脓毒症显著更高（均P < 0.001）。
BSI是创伤ICU中常见的医疗相关感染，且与更差的结局相关。必须更好地遵守感染控制措施及预防原发性BSI的指南。
