Ruoming Tan1, Jialin Liu1, Meiling Li1, Jie Huang1, Jingyong Sun2, Hongping Qu3. 1. Department of Critical Care Medicine and Respiratory Intensive Care Unit, Shanghai Ruijin Hospital Affiliated with Jiaotong University, Shanghai, China. 2. Department of Microbiology, Shanghai Ruijin Hospital Affiliated with Jiaotong University, Shanghai, China. 3. Department of Critical Care Medicine and Respiratory Intensive Care Unit, Shanghai Ruijin Hospital Affiliated with Jiaotong University, Shanghai, China. Electronic address: hongpingqu@yahoo.com.cn.
Abstract
BACKGROUND/ PURPOSE: The aim of this study was to classify intensive care unit (ICU) bacterial strains as either ICU-acquired or ICU-on-admission and to compare their epidemiological and antibiogram characteristics. METHODS: The study was performed in a 1300-bed university-affiliated hospital from January 1, 2006 to December 31, 2010. Based on the time of ICU admission, ICU isolates were classified as ICU-acquired strains (appearing more than 48 hours after admission) or ICU-on-admission strains (appearing 48 hours or less from admission). The microbiological data before ICU admission, the microbiological data, and susceptibility testing were compared between the ICU-acquired and ICU-on-admission bacterial isolates. RESULTS: The most common ICU-acquired strains were Acinetobacter baumannii (19.5%), Pseudomonas aeruginosa (15.6%), Stenotrophomonas maltophilia (11.5%), Staphylococcus aureus (10.7%), Enterococcus spp. (10.6%), and Klebsiella pneumoniae (9.7%). There were significant differences between ICU-acquired and ICU-on-admission isolates in the susceptibility rates of Gram-negative bacteria to antibiotics, especially the susceptibility of A. baumannii to imipenem [23.8% (ICU-acquired) vs. 44.4% (ICU-on-admission), p < 0.001] and meropenem (24.1% vs. 37.8%, p < 0.001), and the susceptibility of P. aeruginosa to imipenem (39.3% vs. 76.1%, p < 0.001) and meropenem (58.5% vs. 76.1%, p < 0.05). Furthermore, decreased susceptibility rates of A. baumannii and P. aeruginosa to carbapenems were correlated with an extended ICU stay (p < 0.05). CONCLUSION: Because of decreasing susceptibility rates of pathogens (especially ICU-acquired strains) and a significant correlation with the length of ICU stay, intensivists should consider a patient's time of ICU admission and previous microbiological data and should distinguish ICU-acquired strains from non-ICU-acquired strains so as to initiate optimized empirical antibiotic therapy against ICU-acquired infections.
BACKGROUND/ PURPOSE: The aim of this study was to classify intensive care unit (ICU) bacterial strains as either ICU-acquired or ICU-on-admission and to compare their epidemiological and antibiogram characteristics. METHODS: The study was performed in a 1300-bed university-affiliated hospital from January 1, 2006 to December 31, 2010. Based on the time of ICU admission, ICU isolates were classified as ICU-acquired strains (appearing more than 48 hours after admission) or ICU-on-admission strains (appearing 48 hours or less from admission). The microbiological data before ICU admission, the microbiological data, and susceptibility testing were compared between the ICU-acquired and ICU-on-admission bacterial isolates. RESULTS: The most common ICU-acquired strains were Acinetobacter baumannii (19.5%), Pseudomonas aeruginosa (15.6%), Stenotrophomonas maltophilia (11.5%), Staphylococcus aureus (10.7%), Enterococcus spp. (10.6%), and Klebsiella pneumoniae (9.7%). There were significant differences between ICU-acquired and ICU-on-admission isolates in the susceptibility rates of Gram-negative bacteria to antibiotics, especially the susceptibility of A. baumannii to imipenem [23.8% (ICU-acquired) vs. 44.4% (ICU-on-admission), p < 0.001] and meropenem (24.1% vs. 37.8%, p < 0.001), and the susceptibility of P. aeruginosa to imipenem (39.3% vs. 76.1%, p < 0.001) and meropenem (58.5% vs. 76.1%, p < 0.05). Furthermore, decreased susceptibility rates of A. baumannii and P. aeruginosa to carbapenems were correlated with an extended ICU stay (p < 0.05). CONCLUSION: Because of decreasing susceptibility rates of pathogens (especially ICU-acquired strains) and a significant correlation with the length of ICU stay, intensivists should consider a patient's time of ICU admission and previous microbiological data and should distinguish ICU-acquired strains from non-ICU-acquired strains so as to initiate optimized empirical antibiotic therapy against ICU-acquired infections.
Authors: Duong Bich Thuy; James Campbell; Nguyen Van Minh Hoang; Truong Thi Thuy Trinh; Ha Thi Hai Duong; Nguyen Chi Hieu; Nguyen Hoang Anh Duy; Nguyen Van Hao; Stephen Baker; Guy E Thwaites; Nguyen Van Vinh Chau; C Louise Thwaites Journal: PLoS One Date: 2017-09-14 Impact factor: 3.240