Bacteraemia in Intensive Care Unit: Clinical, Bacteriological, and Prognostic Prospective Study

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Microbiology

Background:

• Bacteraemia poses a significant threat in intensive care units (ICUs).
• Understanding the epidemiology and antimicrobial resistance patterns of bacteraemia is vital for effective patient management.

Purpose of the Study:

• To describe the epidemiology of bacteraemia in the ICU of Mohammed V Military Teaching Hospital, Rabat.
• To identify common pathogens and their antibiotic resistance profiles.
• To assess the impact of early antibiotic administration on patient outcomes.

Main Methods:

• A one-year observational study (December 2012-November 2013) monitoring ICU blood cultures.
• Analysis of bacteriological profiles, clinical significance, and sources of bacteraemia.
• Evaluation of antibiotic resistance, including extended-spectrum beta-lactamases (ESBLs) and carbapenemase production.
• Assessment of the adequacy and timing of empirical antibiotic therapy.

Main Results:

• 46 episodes of bacteraemia occurred (15.4/1000 patients), with 97% being nosocomial.
• Gram-negative bacteria predominated (83.6%), with Acinetobacter baumannii being the most frequent pathogen.
• High rates of antibiotic resistance were observed: 42.5% of Enterobacteriaceae produced ESBLs, and 100% of Acinetobacter baumannii produced carbapenemases.
• The lungs were the most common source (33%), but no source was identified in 52% of cases.
• Adequate empirical antibiotic therapy within 24 hours was administered in 72% of cases.

Conclusions:

• Bloodstream infections in the ICU primarily affect patients over 55 with comorbidities like hypertension and diabetes.
• Multidrug-resistant Gram-negative bacteria are the main causative agents.
• Prompt initiation of appropriate antibiotic therapy significantly improves patient survival rates.