Severe infection is a common reason for intensive care and contributes to increased morbidity and mortality. The aim of this study was to identify clinical differences in patients with bacteremia between newly opened medical intensive care unit(MICU) and longstanding medico-surgical ICU(MSICU) patients and to evaluate the consequence of ICU or community-acquired infection on morbidity and mortality.
A total of 61 patients(MICU 37, MSICU 24) with bacteremia admitted for more than 48hr to the MICU or MSICU at Pusan Natinal University Hospital from 1 March 2002 to 18 August 2003 were retrospectively evaluated. Medical records were reviewed to obtain the clinical and bacteriologic informations.
The mean age of the patients with bacteremia of MICU(60.8 ± 13.5 yr) was greater than that of MSICU(55.2 ± 18.3 yr)(p < 0.05), and the average day of hospital and ICU stay was shorter in MICU patients than MSICU patients(p < 0.05). The prevalence of community-acquired infections was significantly higher in MICU patients than in MSICU patients(MICU 18.8%, MSICU 5.0%)(p < 0.01) whereas MSICU patients showed higher prevalence of hopital-acquired infection than MICU patients(MICU 84.4%, MSICU 95%)(p < 0.05). The common primary sites of infection were catheter-related infection, pneumonia and urinary tract infection(UTI). The most common pathogenic organisms in MICU and MSICU were methicillin-resistant staphylococcus aureus(MRSA) and Acinetobacter baumanii, respectively. A significant proportion of bacteremia was originated from candida spicies(MICU 10.8%, MSICU 12.5%). The most relevant independent factors associated with mortality rate were bacteremia due to vancomycin-resistant enterococci(VRE) or extended spectrum β-lactamase(ESBL) producing bacteria and candidemia. Also, the mortality rate of ICU patients was associted with previous use of antibiotics or immunosuppressive, primary focus of infection and hospital days.
These findings are useful for empirical treatment of ICU patients and for implementation of strict infection control policy in our hospital.
These results may help in reducing high mortality rate of ICU patients.
Y.S. Kim, None.