Cardozo Júnior Luis Carlos Maia, Bianchini Larissa, Giovanetti Jakeline Neves, Araújo Luiz Marcelo Almeida de, Santos Yuri de Albuquerque Pessoa Dos, Besen Bruno Adler Maccagnan Pinheiro, Park Marcelo
Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas, Departamento de Emergência, Unidade de Terapia Intensiva, São Paulo, SP, Brazil.
Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas, Departamento de Emergência, Unidade de Terapia Intensiva, São Paulo, SP, Brazil.
Braz J Anesthesiol. 2025 Jan-Feb;75(1):844567. doi: 10.1016/j.bjane.2024.844567. Epub 2024 Oct 24.
Infection diagnosis in Intensive Care Units (ICUs) is a challenge given the spectrum of conditions that present with systemic inflammation, the illness severity and the delay and imprecision of existing diagnostic methods. We hence sought to analyze the prevalence and predictors of confirmed infection after empirical antimicrobials during ICU stay.
retrospective cohort of prospectively collected ICU data in an academic tertiary hospital in São Paulo, Brazil. We included all adult patients given a new empirical antimicrobial during their ICU stay. We excluded patients using prophylactic or microbiologically guided antimicrobials. Primary outcome was infection status, defined as confirmed, probable, possible, or discarded. In a multivariable analysis, we explored variables associated with confirmed infection.
After screening 1721 patients admitted to the ICU from November 2017 to November 2022, we identified 398 new antimicrobial prescriptions in 341 patients. After exclusions, 243 antimicrobial prescriptions for 206 patients were included. Infection was classified as confirmed in 61 (25.1%) prescriptions, probable in 39 (16.0%), possible in 103 (42.4%), and discarded in 40 (16.5%). The only factor associated with infection was deltaSOFA (OR = 1.18, 95% CI 1.02 to 1.36, p = 0.022).
Suspected infection in the ICU is frequently not confirmed. Clinicians should be aware of the need to avoid premature closure and revise diagnosis after microbiological results. Development and implementation of new tools for faster infection diagnosis and guiding of antimicrobial prescription should be a research priority.
鉴于重症监护病房（ICU）中出现全身炎症的一系列病症、疾病严重程度以及现有诊断方法的延迟和不精确性，ICU中的感染诊断是一项挑战。因此，我们试图分析在ICU住院期间经验性使用抗菌药物后确诊感染的患病率和预测因素。
对巴西圣保罗一家学术性三级医院前瞻性收集的ICU数据进行回顾性队列研究。我们纳入了所有在ICU住院期间接受新的经验性抗菌药物治疗的成年患者。我们排除了使用预防性或微生物学指导抗菌药物的患者。主要结局是感染状态，定义为确诊、可能、疑似或排除。在多变量分析中，我们探讨了与确诊感染相关的变量。
在筛选了2017年11月至2022年11月入住ICU的1721例患者后，我们在341例患者中确定了398份新的抗菌药物处方。排除后，纳入了206例患者的243份抗菌药物处方。61份（25.1%）处方的感染被分类为确诊，39份（16.0%）为可能，103份（42.4%）为疑似，40份（16.5%）为排除。与感染相关的唯一因素是序贯器官衰竭评估（SOFA）评分变化（OR = 1.18，95%CI 1.02至1.36，p = 0.022）。
ICU中疑似感染常常未得到确诊。临床医生应意识到避免过早定论并在微生物学结果出来后重新评估诊断的必要性。开发和应用用于更快感染诊断及指导抗菌药物处方的新工具应是研究重点。
