Bolničke infekcije krvotoka u mehanički ventiliranih infektoloških bolesnika starije životne dobi [Intensive care unit acquired bloodstream infections – impact of the patient`s age]

Balen Topić, Mirjana (2011) Bolničke infekcije krvotoka u mehanički ventiliranih infektoloških bolesnika starije životne dobi [Intensive care unit acquired bloodstream infections – impact of the patient`s age]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Introduction: The intensive care units (ICU) aquired infections are the rising problem of the modern medicine and the little is known about the relationship between older age and ICU acquired infections. ----- Objective: To assess the relationship between the older age and risk for acquisition of ICU aquired bloodstream infections (BSI), determine their outcome and epidemiology. ----- Design: Retrospective cohort study. ----- Setting: ICU of the University Hospital for Infectious Diseases, Zagreb. ----- Patients: Mechanically ventilated infectious disease patients of both sexes ≥18 yrs, treated in ICU ≥48h from 1994-2008. ----- Methods: Uni-, bi- and multi-variate analysis, „propensity score“ calculation. ----- Results: Of 1093 patients 46.6% were ≥65 yrs. and 23.4% had BSI. The corelation between age and BSI aquisition was not found (OR:0.992, 95%CI: 0.712-1.381). Although showing significantly longer ICU stay, tendency of better survival and 28- days survival was found among patients ≥65 yrs. with BSI (p=0.0686, p=0.047). Etiology of 353 episodes of BSI was similar in both age-groups (p=0.4940); nonfermenting gram-negative bacteria: 32.0% (MDR 4.5%), enterobacteria: 24.1% (ESBL+CEF3 R 14.2%), gram-positive bacteria 18.1% (MRSA 9.3%, ARE 1.1%), polymicrobial: 17.6%, Candida sp: 7.1%, other: 1.1%. ----- Conclusions: No correlation between older age and BSI acquisition was found. Analyses showed significantly longer ICU stay, but better overall and 28-day survival among patients ≥65 yrs. with BSI. No differencies were found in etiology and resistance pattern of BSI episodes between observed age-groups.

Abstract in Croatian

Uvod: Infekcije nastale tijekom liječenja u jedinici intenzivne medicine (JIM) predstavljaju rastući problem suvremene medicine i malo se zna o odnosu starije životne dobi i u JIM nastalih infekcija. ----- Cilj: Utvrditi odnos starije životne dobi i rizika nastanaka bolničkih infekcija krvotoka (BIK) u JIM, utvrditi njihov ishod i epidemiologiju. ----- Ustroj: Retrospektivno kohortno istraživanje. ----- Ustanova: JIM Klinike za infektivne bolesti, Zagreb. ----- Bolesnici: Mehanički ventilirani infektološki bolesnici oba spola ≥18 g, liječeni u JIM ≥48h od 1994-2008. ----- Metode: Uni i bivarijantne analize, multivarijantna analiza, izračunavanje „propensity“ skorova. -----Rezultati: Od 1093 bolesnika 46.6% je bilo ≥65 g, a 23.4% je imalo BIK. Dob bolesnika nije bila povezana s vjerojatnošću nastanka BIK (OR:0.992, 95%CI: 0.712- 1.381). Iako su bili značajno duže liječeni u JIM, utvrđena je tendencija boljeg preživljavanja i 28-dnevnog preživljavanja u bolesnika ≥65 g. s BIK (p=0.0686 i p=0.047). Etiologija 353 BIK je bila podjednaka u promatranim dobnim skupinama (p=0.4940); nefermentirajuće gram-negativne bakterije: 32.0% (MDR 4.5%), enterobakterije: 24.1% (ESBL+CEF3 R 14.2%), gram-pozitivne bakterije: 18.1% (MRSA 9.3%, enterokoki rezistentni na ampicilin 1.1%), polimikrobne: 17.6%, kandida: 7.1%, ostalo: 1.1%. ----- Zaključak: Starija životna dob nije bila povezana s vjerojatnošću nastanka BIK. Bolesnici ≥65 g. s BIK su bili značajno duže liječeni u JIM, ali su imali bolje ukupno i 28-dnevno preživljavanje. Nije utvrđena razlika u etiologiji niti u antimikrobnoj osjetljivosti uzročnika BIK između promatranih dobnih skupina.

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