Supervisors info:
Νανάς Σεραφείμ, Καθηγητής, Ιατρική σχολή, ΕΚΠΑ
Χριστίνα Ρούτση, Καθηγήτρια, Ιατρική σχολή, ΕΚΠΑ
Ιωάννης Α. Βασιλειάδης, Επίκουρος Καθηγητής, Ιατρική σχολή, ΕΚΠΑ
Summary:
The infections due to multi-resistant bacteria pose a universal threat for the public health and are related to high mortality rate, morbidity, length of hospital stay and cost of nursing.
The aim of this research paper is to correlate patients’ condition at their Intensive Care Unit (ICU) admission with multi-resistant bacteria colonization during the ICU care, as also to evaluate the correlation between the presence of multi-resistant bacteria in ICU patients and the length of stay in mechanical ventilation and under sedation.
Methodology: This research paper is a prospective and descriptive observational study that was conducted at the ICU of General Hospital of Athens “O Evaggelismos” with a duration of six months. At this research participated all patients of the ICU department with an-at least-3 day long stay in mechanical ventilation. For all patients, who met the admission criteria, their demographic data, their cause of admission to the ICU, the presence of underlying diseases as well as the degree of severity at admission after its evaluation with the SOFA and APACHEII scales were recorded. The duration of the mechanical ventilation and sedation, the duration of the ICU stay, as well as, the results at their ICU discharge were also recorded. Lastly, there were also recorded the first positive multi-resistant bacteria cultivations from the day of the ICU admission until the ICU discharge.
Results: During the research, 175 patients were admitted to the ICU. The 69 patients, out of the 175 patients remained in the research procedure and 106 patients were excluded from it. 32 out of the 69 patients, who remained in the research procedure, appeared a first multi-resistant bacteria colonization either in blood culture or in urine culture or in bronchial secretions. According to the results, the presence of a multi-resistant bacteria was associated with long-term mechanical ventilation (22.13±16.44 days vs. 11.89±11.98, p= 0.005) and under sedation (18.17±17.37 vs. 10.30±10.97, p=0.0227). 46.6% (n=32) of the patients admitted to the research study displayed multi-resistant bacteria cultivation in the first bronchial secretions culture or blood culture or urine culture. As for the correlation between the resistance levels and their Gram stain, the findings showed that 32 of the patients who were colonized with multi-resistant bacteria, the 62.5% (n=20) of them developed MDR bacteria, the 31.3% (n=10) of them developed XDR bacteria and the 6.3% (n=2) of them developed PDR bacteria. In the matter of the Gram stain, it appeared that the 96.9% (n=31) of them belongs to GRAM-negative bacteria and the 3.1% (n=1) belongs to GRAM-positive bacteria. Lastly, there was no correlation between the development of multi-resistant bacteria and the patients’ condition at their ICU admission.
Conclusion: The results of the research study show that the presence of multi-resistant bacteria is associated with long-term stay in both mechanical ventilation and sedation.
High rates of nosocomial infections in ICU due to multi-resistant bacteria result in increased mortality rate and morbidity, increased length of hospital stay and increased cost of nursing.
According to studies, the factors for the development of multi-resistant bacteria in the ICU are the intervention devices, the inappropriate use of antibiotics, the immunosuppression, the microbial dispersion, the presence of underlying diseases, the severity of the disease at the admission, the patient's age, and the length of hospital stay.
Therefore, observation strategies of the nosocomial infections, observation cultures, proper hand hygiene protocols, proper hygiene of medical equipment and ICU surfaces protocols are important steps in providing good care and prevention of multi-resistant bacteria dispersion.
And lastly, it is necessary to conduct multicenter researches to capture the problem in a better way.
Keywords:
ICU, Multi-Resistant Bacteria, Infections, Critically ill
