Microbiological Profile of Organisms Causing Bloodstream Infection in Critically Ill Patients

Abstract

BackgroundBloodstream infection (BSI) is the most frequent infection in critically ill patients. As BSI’s among patients in intensive care units (ICU’s) are usually secondary to intravascular catheters, they can be caused by both Gram-positive and Gram-negative microorganisms as well as fungi. Infection with multidrug-resistant (MDR) organisms is becoming more common, making the choice of empirical antimicrobial therapy challenging. The objective of this study is to evaluate the spectrum of microorganisms causing BSI’s in a Medical-Surgical Intensive Care Unit (MSICU) and their antimicrobial resistance patterns.MethodsA prospective observational study among all adult patients with clinical signs of sepsis was conducted in a MSICU of an inner-city hospital in New York City between May 1, 2010 and May 30, 2011.ResultsA total of 722 adult patients with clinical signs of systemic inflammatory response syndrome (SIRS) and/or sepsis were admitted to the MSICU between May 1, 2010 and May 30, 2011. From those patients, 91 (12.6%) had one or more positive blood culture. A 122 isolates were identified: 72 (59%) were Gram-positive bacteria, 38 (31.1%) were Gram-negative organisms, and 12 (9.8%) were fungi. Thirteen (34.2%) Gram-negative organisms and 14 (19.4%) Gram-positive bacteria were classified as MDR.ConclusionsAntimicrobial resistance, particularly among Gram-negative organisms, continues to increase at a rapid rate, especially in the ICU’s. Coordinated infection control interventions and antimicrobial stewardship policies are warranted in order to slow the emergence of resistance.

Systematic review: human gut dysbiosis induced by non‐antibiotic prescription medications

“…Thus, specific taxonomic alterations are consistently associated with some medications, essentially defining non‐antibiotic prescription drug‐induced bacterial profiles. These genera include the most frequently isolated pathogens from blood culture samples of patients with sepsis, especially critically ill and cancer patients . In mice, domination by the family Enterobacteriaceae following antibiotic treatment resulted in clinically ill animals .…”

Antibiotic resistance in sepsis patients: Evaluation and recommendation of antibiotic use

“…[1] The global escalation in both community- and hospital-acquired antimicrobial-resistant bacteria is increasingly compromising effective antimicrobial therapy, particularly when it comes to empiric antimicrobial selection. [6] The appropriate use of an empirical antibiotic is critical to decrease the mortality rate of sepsis[1] and should be started within 1-2 h after the diagnosis of severe sepsis. [7]…”

Microbiologic characteristics and predictors of mortality in bloodstream infections in intensive care unit patients: A 1-year, large, prospective surveillance study in 5 Italian hospitals

“…13 Furthermore, over the last decade, there has been a dramatic increase in nosocomial MDR bacterial strains in the United States and Europe, particularly among isolates recovered from ICU patients. [14][15][16][17] In particular, carbapenem resistance was reported in nearly 70% of Acinetobacter spp and 40% of Klebsiella spp, and an extended spectrum beta lactamases pattern was expressed in up to 30% of Enterobacteriaceae isolates globally. [18][19][20] The present study investigated the annual incidence of BSI in adult ICUs of 5 hospitals (3 teaching hospitals and 2 nonteaching hospitals) in Rome, Italy, in an attempt to quantify the rate of bacteremia per year, the microbiologic epidemiology and diffusion of antibiotic-resistant pathogens, and the risk factors associated with in-hospital mortality after a BSI episode.…”