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Infections in critically ill patients: experience in MICU at a major teaching hospital
N S Dahmash1, S C Arora, D F Fayed
1Dept. of Pulmonary Critical Care Medicine, College of Medicine, Riyadh, Saudi Arabia.
Abstract:
During a one-year period 105 patients suffering a total of 134 infectious episodes were studied prospectively in the medical intensive care unit (MICU). These patients included 54 male and 51 female patients, age ranging from 14 to 100 years (median = 54 years). The overall incidence of infection was 46.7%. Infections acquired in medical wards accounted for 47.8% of the total, followed by community-acquired infections in 27.0%, and MICU-acquired infections in 25.2% of the cases. The most frequent infections were pneumonia and septicaemia accounting for 88% of the total, whereas urinary tract (4.4%), gastrointestinal tract (5.0%), skin and wound infections (2.5%) constituted only 11.5%. The pathogens mainly involved were gram-negative rods, Staphylococcus spp. and Streptococcus pneumoniae. However, in community-acquired pneumonia, the major pathogens were gram-negative rods. In addition, Mycobacterium tuberculosis was an important cause of pneumonia in these patients. The majority of patients had a monoinfection; multiple pathogens were isolated in 11.9% of the episodes. The overall mortality was 46.7%. Several factors that influenced the mortality in these patients were analyzed. Early recognition of these factors may reduce morbidity and mortality.
Insights
This study investigated infections in a medical intensive care unit (MICU), finding pneumonia and septicaemia most common. Early recognition of factors influencing high mortality is crucial for patient outcomes.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Infections are a significant concern in intensive care settings.
- Understanding infection patterns and causative agents is vital for improving patient care.
- The medical intensive care unit (MICU) presents unique challenges for infection control.
Purpose of the Study:
- To prospectively study infectious episodes in a medical intensive care unit (MICU).
- To identify the incidence, types, and causative pathogens of infections.
- To analyze factors influencing mortality in critically ill patients.
Main Methods:
- Prospective study of 105 patients over one year in a MICU.
- Documented 134 infectious episodes, analyzing infection sources and types.
- Identified pathogens and assessed factors affecting patient mortality.
Main Results:
- Overall infection incidence was 46.7%, with ward-acquired infections most frequent.
- Pneumonia and septicaemia constituted 88% of infections; gram-negative rods were primary pathogens.
- Overall mortality was 46.7%, with several factors identified as influencing outcomes.
Conclusions:
- Infections in the MICU are common, with pneumonia and septicaemia being predominant.
- Gram-negative rods are significant pathogens, including in community-acquired pneumonia.
- Identifying mortality predictors is essential for reducing morbidity and mortality in MICU patients.