Intensive care unit-acquired bacteremia in mechanically ventilated patients: clinical features and outcomes.

Intensive care unit (ICU)-acquired bacteremia (IAB) is associated with high medical expenditure and mortality. Mechanically ventilated patients represent one third of all patients admitted to ICU, but the clinical features and outcomes in mechanically ventilated patients who develop IAB remain unkno...

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Autores principales:	Hsin-Kuo Ko, Wen-Kuang Yu, Te-Cheng Lien, Jia-Horng Wang, Arthur S Slutsky, Haibo Zhang, Yu Ru Kou
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/a26e47a4c80a472192d307bd32e9c279
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spelling	oai:doaj.org-article:a26e47a4c80a472192d307bd32e9c2792021-11-18T08:40:37ZIntensive care unit-acquired bacteremia in mechanically ventilated patients: clinical features and outcomes.1932-620310.1371/journal.pone.0083298https://doaj.org/article/a26e47a4c80a472192d307bd32e9c2792013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24376683/?tool=EBIhttps://doaj.org/toc/1932-6203Intensive care unit (ICU)-acquired bacteremia (IAB) is associated with high medical expenditure and mortality. Mechanically ventilated patients represent one third of all patients admitted to ICU, but the clinical features and outcomes in mechanically ventilated patients who develop IAB remain unknown. We conducted a 3-year retrospective observational cohort study, and 1,453 patients who received mechanical ventilation on ICU admission were enrolled. Among patients enrolled, 126 patients who had developed IAB ≧48 hours after ICU admission were identified. The study patients were divided into IAB and no IAB groups, and clinical characteristics of IAB based on specific bacterial species were further analyzed. The multivariate Cox regression analysis showed that ventilator support for chronic obstructive pulmonary disease and congestive heart failure, and patients admitted from nursing home were the independent risk factors for developing IAB. Patients with IAB were significantly associated with longer length of ICU stay, prolonged ventilator use, lower rate of successful weaning, and higher rate of ventilator dependence and ICU mortality as compared to those without IAB. IAB was the independent risk factor for ICU mortality (HR, 1.510, 95% CI 1.054-1.123; p = 0.010). The clinical characteristics of IAB related to specific bacterial species included IAB due to Pseudomonas aeruginosa being likely polymicrobial, lung source and prior antibiotic use; Escherichia coli developing earlier and from urinary tract source; methicillin-resistant Staphylococcus aureus related to central venous catheter and multiple sets of positive hemoculture; and Elizabethkingia meningoseptica significantly associated with delayed/inappropriate antibiotic treatment. In summary, IAB was significantly associated with poor patient outcomes in mechanically ventilated ICU patients. The clinical features related to IAB and clinical characteristics of IAB based on specific bacterial species identified in our study may be utilized to refine the management of IAB.Hsin-Kuo KoWen-Kuang YuTe-Cheng LienJia-Horng WangArthur S SlutskyHaibo ZhangYu Ru KouPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 12, p e83298 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Hsin-Kuo Ko Wen-Kuang Yu Te-Cheng Lien Jia-Horng Wang Arthur S Slutsky Haibo Zhang Yu Ru Kou Intensive care unit-acquired bacteremia in mechanically ventilated patients: clinical features and outcomes.
description	Intensive care unit (ICU)-acquired bacteremia (IAB) is associated with high medical expenditure and mortality. Mechanically ventilated patients represent one third of all patients admitted to ICU, but the clinical features and outcomes in mechanically ventilated patients who develop IAB remain unknown. We conducted a 3-year retrospective observational cohort study, and 1,453 patients who received mechanical ventilation on ICU admission were enrolled. Among patients enrolled, 126 patients who had developed IAB ≧48 hours after ICU admission were identified. The study patients were divided into IAB and no IAB groups, and clinical characteristics of IAB based on specific bacterial species were further analyzed. The multivariate Cox regression analysis showed that ventilator support for chronic obstructive pulmonary disease and congestive heart failure, and patients admitted from nursing home were the independent risk factors for developing IAB. Patients with IAB were significantly associated with longer length of ICU stay, prolonged ventilator use, lower rate of successful weaning, and higher rate of ventilator dependence and ICU mortality as compared to those without IAB. IAB was the independent risk factor for ICU mortality (HR, 1.510, 95% CI 1.054-1.123; p = 0.010). The clinical characteristics of IAB related to specific bacterial species included IAB due to Pseudomonas aeruginosa being likely polymicrobial, lung source and prior antibiotic use; Escherichia coli developing earlier and from urinary tract source; methicillin-resistant Staphylococcus aureus related to central venous catheter and multiple sets of positive hemoculture; and Elizabethkingia meningoseptica significantly associated with delayed/inappropriate antibiotic treatment. In summary, IAB was significantly associated with poor patient outcomes in mechanically ventilated ICU patients. The clinical features related to IAB and clinical characteristics of IAB based on specific bacterial species identified in our study may be utilized to refine the management of IAB.
format	article
author	Hsin-Kuo Ko Wen-Kuang Yu Te-Cheng Lien Jia-Horng Wang Arthur S Slutsky Haibo Zhang Yu Ru Kou
author_facet	Hsin-Kuo Ko Wen-Kuang Yu Te-Cheng Lien Jia-Horng Wang Arthur S Slutsky Haibo Zhang Yu Ru Kou
author_sort	Hsin-Kuo Ko
title	Intensive care unit-acquired bacteremia in mechanically ventilated patients: clinical features and outcomes.
title_short	Intensive care unit-acquired bacteremia in mechanically ventilated patients: clinical features and outcomes.
title_full	Intensive care unit-acquired bacteremia in mechanically ventilated patients: clinical features and outcomes.
title_fullStr	Intensive care unit-acquired bacteremia in mechanically ventilated patients: clinical features and outcomes.
title_full_unstemmed	Intensive care unit-acquired bacteremia in mechanically ventilated patients: clinical features and outcomes.
title_sort	intensive care unit-acquired bacteremia in mechanically ventilated patients: clinical features and outcomes.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/a26e47a4c80a472192d307bd32e9c279
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Intensive care unit-acquired bacteremia in mechanically ventilated patients: clinical features and outcomes.

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