Ababneh Mera A, Al Domi Mohammad, Rababa'h Abeer M
Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
Heliyon. 2022 Aug 4;8(8):e10076. doi: 10.1016/j.heliyon.2022.e10076. eCollection 2022 Aug.
Bloodstream infections (BSIs) are one of the most critical illnesses requiring intensive care unit (ICU) admission. Antimicrobial therapy (AMT) is one of the vital management strategies for the treatment of BSIs; it should be chosen appropriately to reduce mortality.
This is the first study to investigate the types of antimicrobial agents administered in the ICU setting and the predictor variables associated with mortality.
This retrospective study was conducted at King Abdullah University Hospital (KAUH). All hospitalized patients admitted to the ICU and received at least one antimicrobial agent over 3 years period (January 1, 2017, to December 31, 2019) were included in the study. Electronic patients' medical records were used to collect patients' demographic and clinical characteristics, patient general health status, events that occurred during hospitalization, and events after obtaining the blood culture. Descriptive analysis was done to identify the types of antimicrobials used and the distribution of the microorganisms among the study participants. The susceptibility test of the bloodstream culture was checked for each patient Moreover, crude mortality and its associated factors were investigated.
A total of 1051 patients were enrolled in the study, where 650 patients (61.84%) were treated with three or more antimicrobial agents. The most frequent antimicrobials used were piperacillin/tazobactam followed by teicoplanin, meropenem, and levofloxacin. About half of the patients died within 30-days of BSI, which was associated with several factors including advanced age, presence of co-morbidities, nosocomial infections or healthcare-associated infections, length of ICU stay, respiratory tract infections, receiving vasopressor during the hospital stay, concurrent positive culture other than blood with BSI, receiving combination antimicrobial therapy, those who were complicated with septic shock or renal failure, receiving total parenteral protein (TPN) nutrition, and inappropriate empiric antimicrobial therapy.
In conclusion, the administration of the antimicrobials among ICU patients was highly based on a combination of three or more agents covering a broad spectrum of microorganisms. The mortality rate was high among patients which were associated with inappropriate empirical therapy. Therefore, the antimicrobial stewardship (ASP) protocol has to be evaluated in the hospital for ICU patients. Moreover, we suggest recommending that hospital policies should apply the ASP protocol, infection control, implement the antimicrobial de-escalation protocol, and do best controlling on the co-morbid conditions, especially for ages 65 years or more to reduce the mortality rate in the ICU.
血流感染（BSIs）是最严重的疾病之一，需要入住重症监护病房（ICU）。抗菌治疗（AMT）是治疗血流感染的重要管理策略之一；应适当选择以降低死亡率。
这是第一项研究ICU环境中使用的抗菌药物类型以及与死亡率相关的预测变量的研究。
这项回顾性研究在阿卜杜拉国王大学医院（KAUH）进行。纳入了在3年期间（2017年1月1日至2019年12月31日）入住ICU并接受至少一种抗菌药物治疗的所有住院患者。使用电子病历收集患者的人口统计学和临床特征、患者一般健康状况、住院期间发生的事件以及获得血培养后的事件。进行描述性分析以确定所使用的抗菌药物类型以及研究参与者中微生物的分布。检查每位患者血流培养的药敏试验。此外，调查了粗死亡率及其相关因素。
共有1051名患者纳入研究，其中650名患者（61.84%）接受了三种或更多种抗菌药物治疗。最常用的抗菌药物是哌拉西林/他唑巴坦，其次是替考拉宁、美罗培南和左氧氟沙星。约一半的患者在血流感染后30天内死亡，这与几个因素有关，包括高龄、合并症的存在、医院感染或医疗保健相关感染、ICU住院时间、呼吸道感染、住院期间接受血管加压药、除血流感染外血液以外的并发阳性培养、接受联合抗菌治疗、并发感染性休克或肾衰竭的患者、接受全胃肠外蛋白质（TPN）营养以及不适当的经验性抗菌治疗。
总之，ICU患者中抗菌药物的使用高度基于三种或更多种覆盖广泛微生物的药物联合使用。患者死亡率很高，这与不适当的经验性治疗有关。因此，必须在医院对ICU患者评估抗菌药物管理（ASP）方案。此外，我们建议医院政策应应用ASP方案、感染控制、实施抗菌药物降阶梯方案，并最好控制合并症，特别是对于65岁及以上的患者，以降低ICU的死亡率。
