Microbiological surveillance of the surgical intensive care unit in Zagreb: a pivot for guideline-based therapy of severe sepsis

Mihaljević, Ljiljana and Bedenić, Branka and Mihaljević, Slobodan and Majerović, Mate and Petrović, Pavo and Vasilj, Ivan (2007) Microbiological surveillance of the surgical intensive care unit in Zagreb: a pivot for guideline-based therapy of severe sepsis. Collegium Antropologicum, 31 (4). pp. 1093-1097. ISSN 0350-6134

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Abstract

The aim of this retrospective study was to create guidelines for therapy of severe sepsis in surgical intensive care unit (ICU) for unknown causative agent based on antimicrobial susceptibility of causative bacteria. Seventy-four patients with severe sepsis from surgical ICU in 2003.-2005. were included in study. Their clinical and microbiological data were analyzed from the medical records. Antimicrobial susceptibility of the strains isolated from the blood-culture was tested by disk diffusion method according to CLSI (Clinical Laboratory Standard Institution). APACHE II score was used to predict the severity of illness. Statistical significance difference between results was tested by Mann-Whitney test and chi2 test. Important problem remained type of sepsis: mono-agent sepsis presented less therapeutic problem than sepsis caused with two or more agents (mixed sepsis). Methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa and Acinetobacter baumannii were predominant causative agents in both type of sepsis. There was remarkable increase of A. baumannii prevalence in 2005 compared to 2004 and to 2003. There was also decrease of MRSA prevalence in 2004 and 2005 compared to 2003. P. aeruginosa were the predominant causative agents in 2004. MRSA displayed good susceptibility to vancomycin and linezolide, whereas P. aeruginosa showed excellent susceptibility to ceftazidime and carbapenems. A. baumannii, third predominant causative agent, exhibited excellent susceptibility to ampicillin+ sulbactam and carbapenems. The recommended therapy is empirical and should cover all important pathogens.

Abstract in Croatian

Retrospektivnom studijom od 01.01.2003. godine do 31.12.2005. godine kod 74 bolesnika iz kirurškog JIL-a KBC-a Zagreb, pratili smo promjene prevalencije uzročnika sepse koristeći se pri tome njihovim kliničkim i mikrobiološkim podacima. Cilj rada bio je odrediti smjernice za početnu antibiotsku terapiju teške sepse kod bolesnika u kirurškom JIL-u. Antimikrobna osjetljivost uzročnika izoliranih iz hemokulture određivana je metodom disk-difuzije prema CLSI (Clinical Laboratory Standard Institution). APACHE II score korišten je za procjenu težine i ishoda bolesti. Mann-Whitney i c2 test služili su za statističku obradu podataka, a kao granica statističke značajnosti uzet je p<0.05. Polimikrobna sepsa je bila posebno težak problem, kako za određivanje definitivne antibiotske terapije, tako i za određivanje empirijske antibiotske terapije. Izolirano je deset različitih uzročnika sepse, a najčešći su: meticilin-rezistentni Staphylococcus aureus (MRSA), Pseudomonas aeruginosa i Acinetobacter baumannii. Njihova prevalencija se mijenjala kroz te tri godine, tako da je MRSA bila vodeći uzročnik sepse u 2003. godini, P. aeruginosa u 2004. a A. baumannii u 2005. Kod naših bolesnika, MRSA je pokazala dobru osjetljivost na vankomicin i linezolid, P. aeruginosa na ceftazidim i karbapeneme, a A. baumannii na ampicilin+sulbaktam i karbapeneme.

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