VALIDITY OF ANTIBIOTIC TREATMENT IN INTENSIVE CARE UNIT OF DEPARTMENT FOR ANESTHESIOLOGY, REANIMATOLOGY AND INTENSIVE CARE OF UNIVERSITY HOSPITAL OF SPLIT ACCORDING TO ISOLATES FROM TRACHEAL ASPIRATES AND URINE CULTURES IN 2017

Abstract

Cilj istraživanja: Cilj istraživanja bio je pokazati učinkovitost antibiotske terapije za bolesnike s respiracijskim i urinarnim infektom u Jedinici intenzivnog liječenja KBC-a Split analizirajući kretanje njihovih parametara upale tijekom trajanja liječenja. Također bilo nam je u cilju utvrditi i ishode liječenja koje smo promatrali kao preživljenje i kao smrt. Materijal i metode: Retrospektivnom analizom povijesti bolesti iz Arhiva Klinike za anesteziologiju, reanimatologiju i intenzivno liječenje KBC-a Split prikupljeni su podaci o svim pacijentima liječenima na JIL-u 2017. godine. Posebno je izdovojena skupina pacijenata s pozitivnim izolatima aspirata traheje ili urinokulture. Rezultati: Rezultati su pokazali veći udio Gram-negativnih bakterija u izolatima iz aspirata traheje (80,90%,) i urinokutura (47,17%). Također, iz urinokultura izoliran je značajan broj gljiva (43,47%). Analizirajući ishode liječenja pokazali smo veću smrtnost među populacijom s unrinarnim (27,7%) nego respiratornim (25,5%) infektom što je bilo suprotno očekivanom. Ukupna smrtnost u obje skupine je 27,1%. Primjena prave terapije u pravo vrijeme u pravoj dozi bitna je odrednica uspješnog liječenja. Dobar odgovor na terapiju vidljiv je u 67,9% respiratornih i 45,7% urinarnih infekcija. Podaci o smrtnosti i odgovoru na terapiju nisu uzimali u obzir hemokulture stoga ih u tom kontekstu treba i shvatiti. Zaključak: Epidemiologija uzročnika na JIL-u približava se svjetskim trendovima u kojima prevladavaju Gram-negativne bakterije, ali antibiotska rezistencija nije još toliko izražena. Primjena antibiotika je opravdana za svaki pozitivan ishod liječenja koji odnosno za svakog pacijenta kojemu antibiotska terapija može više koristiti nego naštetiti. Raniji početak ciljane terapije dovodi do skraćenja trajanja liječenja i bržeg pada upalnih parametara.Objectives: The aim of this study was to show the effectiveness of antibiotic treatment for patients with urinary or respiratory infection in Intensive care unit of University Hospital of Split by analyzing level changes of inflammatory markers. Also, we wanted to determine outcomes of treatment as survival or death. Patients and methods: Data was collected using retrospective analysis of case reports in the Archive of Department of anesthesiology, reanimatology and intensive care of University Hospital of Split. Among all data, group of 85 patients was selected as a study population because of positive trachel aspirate or urine culture Results: Results show higher rates of Gram-negative bacteria in tracheal aspirates (80.90%) than in urine cultures (47.17%). Also, significant amount of fungi was isolated from the urine cultures (43.47%). Analyzing outcomes of treatment, higher mortality rate was showed among patients with urinary (27.7%) than in respiratory (25.5%) infection. Common mortality rate was 27.1%. Right drug in right dosage in right time is also very important factor of good treatment. Good response to therapy (showed as decrease of values of inflammatory markers) is accquired for 67.9% respiratory and 45.7% for urinary infections. Mortality rate data and resoponse to therapy data did not include inffluence of hemocultures. Therefore, this data must be considered in such context. Conclusion: Epidemiology of microorganisms in ICU of Split follows trends of ICUs around the world where higher rates of Gram-negative bacteria are found, but antibiotic resistance is still not very high. Usage of the antibiotics is justified for every patient that presents positive outcome of treatment and the drug can do no harm to them. Earlier begining with targeted therapy leads to shorter days of stay and faster decrease of inflammatory markers