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Bloodstream Infection in the Intensive Care Unit: Evolving Epidemiology and Microbiology
Carly Munro1, Marya D Zilberberg2, Andrew F Shorr2
1Medstar Washington Hospital Center, Washington, DC 20010, USA.
Abstract:
Bloodstream infections (BSIs) arising in the intensive care unit (ICUs) present a significant challenge and we completed a narrative review of the emerging literature on this issue. Multiple reports document that these infections are associated with substantial morbidity and mortality. Also, they can be caused by a variety of pathogens. Generally classified as either community or hospital in onset, or as either primary or secondary in origin, the microbiology of ICU BSIs varies across the globe. Gram-positive pathogens predominate in certain regions such as the United States while Gram-negative organisms occur more frequently in Europe, Asia, and Latin America. The incidence of ICU BSIs climbed during the recent pandemic. BSIs complicating the care of persons suffering from Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection significantly heighten the risk for death compared to patients who develop ICU BSIs but who are not infected with SARS-CoV-2. Furthermore, rates of antimicrobial resistance are generally increasing in ICU BSIs. This fact complicates attempts to ensure that the patient receives initially appropriate antimicrobial therapy and is of particular concern in Methicillin-resistant Staphylococcus aureus, Carbapenem-resistant Enterobacterales, and Acinetobacter baumannii. Fortunately, with respect to clinical application, preventive measures exist, and recent analyses suggest that increased collaboration between infectious disease specialists and intensivists can improve patient outcomes.
Insights
Bloodstream infections (BSIs) in intensive care units (ICUs) cause significant harm. Emerging data show increased incidence, driven by factors like SARS-CoV-2, and rising antimicrobial resistance, complicating patient treatment.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Bloodstream infections (BSIs) in intensive care units (ICUs) are a major cause of patient morbidity and mortality.
- The microbiology of ICU BSIs varies globally, with different predominant pathogens in different regions.
- The incidence of ICU BSIs has increased, particularly during the recent pandemic, and is associated with rising antimicrobial resistance.
Purpose of the Study:
- To conduct a narrative review of the emerging literature on bloodstream infections in intensive care units.
- To summarize the current understanding of ICU BSI epidemiology, causative pathogens, and associated challenges.
- To highlight the impact of recent pandemics and antimicrobial resistance on ICU BSIs and patient outcomes.
Main Methods:
- A narrative review of emerging literature was performed.
- Data on BSI incidence, causative pathogens, geographical variations, and antimicrobial resistance were synthesized.
- The impact of SARS-CoV-2 infection on ICU BSI outcomes was analyzed.
Main Results:
- ICU BSIs are associated with substantial morbidity and mortality.
- Global BSI microbiology differs, with Gram-positive pathogens more common in the US and Gram-negative in other regions.
- The COVID-19 pandemic increased ICU BSI incidence, and rising antimicrobial resistance, especially in Methicillin-resistant Staphylococcus aureus, Carbapenem-resistant Enterobacterales, and Acinetobacter baumannii, complicates treatment.
Conclusions:
- Preventive measures for ICU BSIs are available and crucial for improving patient outcomes.
- Collaboration between infectious disease specialists and intensivists can enhance patient care and outcomes in the context of ICU BSIs.
- Addressing rising antimicrobial resistance and understanding evolving BSI epidemiology are critical for effective management in ICUs.
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