Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
Copyright © 2018 The Korean Society of Critical Care Medicine
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Characteristics | Total (n = 161) | IDC (n = 96) | No IDC (n = 65) | P-value |
---|---|---|---|---|
Age (yr) | 66 (18–95) | 62 (20–91) | 66 (18–95) | 0.526 |
Male sex | 93 (57.8) | 56 (58.3) | 37 (56.7) | 0.872 |
APACHE II scorea | 18 (5–38) | 16 (5–34) | 20 (8–38) | <0.001 |
SOFA scorea | 8 (2–20) | 7 (2–20) | 9 (2–17) | 0.020 |
ICU LOS (day) | 23 (1–430) | 34 (2–430) | 16 (1–177) | 0.003 |
Hospital LOS (day) | 43 (2–431) | 58 (10–431) | 21 (2–422) | <0.001 |
Total MV (day) | 19 (1–430) | 23 (1–430) | 12 (1–118) | 0.012 |
Comorbidity | ||||
Diabetes | 46 (28.6) | 28 (29.2) | 18 (27.7) | 0.861 |
Cardiovascular disease | 37 (23.0) | 19 (19.8) | 18 (27.7) | 0.258 |
Hemato-oncologic disease | 35 (21.7) | 11 (11.5) | 24 (36.9) | <0.001 |
Cerebrovascular disease | 27 (16.8) | 18 (18.8) | 9 (13.8) | 0.520 |
Chronic kidney disease | 22 (13.7) | 14 (14.6) | 8 (12.3) | 0.816 |
Chronic lung diseaseb | 17 (10.6) | 11 (11.5) | 6 (9.2) | 0.796 |
Chronic liver disease | 14 (8.7) | 9 (9.4) | 5 (7.7) | 0.783 |
Neuromuscular disease | 13 (8.1) | 8 (8.3) | 5 (7.7) | >0.999 |
Source of infectionc | ||||
Respiratory | 76 (47.2) | 48 (50.0) | 28 (43.1) | 0.424 |
Catheter-related | 43 (26.7) | 35 (36.5) | 8 (12.3) | 0.001 |
Musculoskeletal and soft tissue | 26 (16.1) | 20 (20.8) | 6 (9.2) | 0.053 |
Intra-abdomen | 12 (7.5) | 6 (6.3) | 6 (9.2) | 0.548 |
Urinary tract | 5 (3.1) | 3 (3.1) | 2 (3.1) | >0.999 |
ICU type | ||||
Medical | 65 (40.4) | 34 (35.4) | 31 (47.7) | 0.142 |
Surgical | 17 (10.6) | 10 (10.4) | 7 (10.8) | >0.999 |
Emergency | 40 (24.8) | 23 (24.0) | 17 (26.2) | 0.853 |
Neurosurgical | 18 (11.2) | 11 (11.5) | 7 (10.8) | >0.999 |
Cardio-stroke | 8 (5.0) | 5 (5.2) | 3 (4.6) | >0.999 |
Trauma | 13 (8.1) | 13 (13.5) | 0 | 0.001 |
Bacteria | ||||
Methicillin-resistant Staphylococcus aureus | 59 (36.6) | 36 (37.5) | 23 (35.4) | 0.868 |
Carbapenem-resistant Acinetobacter baumannii | 59 (36.6) | 37 (38.5) | 22 (33.8) | 0.618 |
Vancomycin-resistant Enterococcus faecium | 20 (12.4) | 11 (11.5) | 9 (13.8) | 0.808 |
ESBL(+) Klebsiella pneumoniae | 18 (11.2) | 11 (11.5) | 7 (10.8) | >0.999 |
ESBL(+) Escherichia coli | 9 (5.6) | 5 (5.2) | 4 (6.2) | >0.999 |
Carbapenem-resistant Pseudomonas aeruginosa | 5 (3.1) | 2 (2.1) | 3 (4.6) | 0.394 |
Period from ICU admission to bacteremia (day) | 9 (0–413) | 10 (0–413) | 7 (0–366) | 0.554 |
Administration of the first recommended antibioticsd | 120 (74.5) | 85 (88.5) | 35 (53.8) | <0.001 |
Period of administration of the first recommended antibiotics (day)d | ||||
Before microorganisms identification | 0 (0–55) | 0 (0–25) | 0 (0–55) | 0.979 |
After microorganisms identification | 7 (0–116) | 14 (0–116) | 0 (0–33) | <0.001 |
Requirement for vasopressora | 82 (50.9) | 39 (40.6) | 43 (66.2) | 0.002 |
Requirement of hemodialysisa | 44 (27.3) | 20 (20.8) | 24 (36.9) | 0.031 |
Requirement for neuromuscular blocking agenta | 39 (24.2) | 19 (19.8) | 20 (30.8) | 0.134 |
28-Day mortality | 84 (52.2) | 37 (38.5) | 47 (72.3) | <0.001 |
Values are presented as median (range) for continuous variables or number (%) for categorical variables.
IDC: infectious disease consultation; APACHE: Acute Physiology and Chronic Health Evaluation; SOFA: Sequential Organ Failure Assessment; ICU: intensive care unit; LOS: length of stay; MV: mechanical ventilation; ESBL: extended-spectrum beta-lactamases.
aAll clinical data was calculated or checked from medical records on blood collection day;
bChronic lung diseases included chronic obstructive pulmonary disease, asthma and bronchiectasis;
cOf total patients, 24 patients had more than two sources of infection;
dThe first recommended antibiotics were known as “drug of choice” and were summarized as follows: methicillin-resistant Staphylococcus aureus, vancomycin; Carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Pseudomonas aeruginosa, colistin; Vancomycin-resistant Enterococcus faecium, Linezolid; Carbapenem, ESBL(+) Klebsiella pneumonia and ESBL(+) Escherichia coli.
Organism |
ESBL (n = 27) |
CRPA & CRAB (n = 64) |
MRSA (n = 59) |
VRE (n = 20) |
||||
---|---|---|---|---|---|---|---|---|
IDC (n = 16) | No IDC (n = 11) | IDC (n = 39) | No IDC (n = 25) | IDC (n = 36) | No IDC (n = 23) | IDC (n = 11) | No IDC (n = 9) | |
Glycopeptide | 6 (37.5) | 4 (36.4) | 13 (33.3) | 10 (40.0) | 30 (83.3) | 19 (82.6) | 1 (9.1)a | 5 (55.6)a |
Carbapenem | 16 (100)a | 5 (45.5)a | 13 (33.3) | 12 (48.0) | 9 (25.0) | 6 (26.1) | 1 (9.1) | 7 (77.8) |
Fluoroquinolone | 1 (6.3) | 4 (36.4) | 1 (2.6)a | 8 (32.0)a | 5 (13.9) | 4 (17.4) | 1 (9.1) | 1 (11.1) |
Third-generation cephalosporins | 0 | 11 (18.2) | 1 (2.6)a | 7 (28.0)a | 5 (13.9) | 3 (13.0) | 0 | 0 |
Anti-pseudomonal penicillin | 0 | 2 (18.2) | 3 (7.7) | 2 (8.0) | 4 (11.1) | 3 (13.0) | 0 | 0 |
Fourth generation cephalosporins | 0 | 0 | 2 (5.1) | 2 (8.0) | 10 (27.8) | 4 (17.4) | 1 (9.1) | 0 |
Colistin | 5 (31.3) | 1 (9.1) | 32 (82.1)a | 13 (52.0)a | 8 (22.2) | 2 (8.7) | 2 (18.2) | 1 (11.1) |
Aminoglycoside | 0 | 0 | 1 (2.6) | 1 (4.0) | 1 (2.8) | 0 | 0 | 0 |
Minocycline | 5 (31.3) | 0 | 15 (38.5)a | 2 (8.0)a | 1 (2.8) | 2 (8.7) | 0 | 1 (11.1) |
Macrolide | 0 | 0 | 3 (7.7) | 2 (8.0) | 1 (2.8) | 0 | 0 | 0 |
Second generation cephalosporins | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Trimethoprim-sulfamethoxazole | 0 | 0 | 1 (2.6) | 1 (4.0) | 0 | 0 | 0 | 1 (11.1) |
Linezolid | 1 (6.3) | 1 (9.1) | 0 | 1 (4.0) | 3 (8.3) | 2 (8.7) | 7 (63.6) | 3 (33.3) |
Tigecycline | 0 | 1 (9.1) | 3 (7.7) | 0 | 0 | 1 (4.3) | 1 (9.1) | 0 |
Values are presented as number (%).
IDC: infectious disease consultation; ESBL: extended-spectrum β-lactamase; CRPA: carbapenem-resistant Pseudomonas aeruginosa; CRAB: carbapenem-resistant Acinetobacter baumannii; MRSA: methicillin-resistant Staphylococcus aureus; VRE: vancomycin-resistant Enterococcus faecium.
aIn the chi-square or Fisher exact tests (for small numbers), significance was defined as P < 0.05.
Factor |
Univariate analysis |
Multivariate analysis |
||
---|---|---|---|---|
HR (95% CI) | P-value | HR (95% CI) | P-value | |
Total patients | ||||
Infectious disease consultation | 0.325 (0.210–0.502) | <0.001 | 0.353 (0.226–0.552) | <0.001 |
Requirement for vasopressorsa | 3.154 (1.980–5.025) | <0.001 | 2.409 (1.483–3.914) | <0.001 |
Requirement for HDa | 2.599 (1.672–4.043) | <0.001 | 1.640 (1.037–2.593) | 0.034 |
Requirement for NMBAsa | 1.978 (1.248–3.314) | 0.004 | 2.357 (1.446–3.843) | 0.001 |
Thrombocytopeniaa | 2.298 (1.436–3.675) | 0.001 | 1.747 (1.078–2.830) | 0.023 |
Hemato-oncologic diseases as comorbidities | 2.187 (1.373–3.483) | 0.001 | - | - |
Age ≥65 yr | 1.591 (1.028–2.460) | 0.037 | - | - |
In patients with SOFA ≥9a | ||||
Infectious disease consultation | 0.313 (0.177–0.554) | <0.001 | 0.298 (0.167–0.532) | <0.001 |
Requirement for NMBAsa | 1.681 (0.959–2.949) | 0.070 | 1.834 (1.033–3.256) | 0.038 |
Requirement for vasopressorsa | 1.968 (0.958–4.041) | 0.065 | - | - |
Requirement for HDa | 1.837 (1.065–3.169) | 0.029 | - | - |
In patients with gram-negative bacteremia | ||||
Infectious disease consultation | 0.203 (0.114–0.361) | <0.001 | 0.180 (0.097–0.333) | <0.001 |
Requirement for vasopressorsa | 3.178 (1.733–5.831) | <0.001 | 3.168 (1.670–6.010) | <0.001 |
Requirement for HDa | 3.047 (1.753–5.298) | <0.001 | 2.607 (1.473–4.614) | 0.001 |
Requirement for NMBAsa | 2.226 (1.249–3.969) | 0.007 | 1.879 (1.025–3.446) | 0.041 |
Thrombocytopeniaa | 1.722 (0.932–3.183) | 0.083 | - | - |
Hemato-oncologic diseases as comorbidities | 1.648 (0.929–2.922) | 0.087 | - | - |
Statistical significance was tested by univariate Cox proportional hazards models and multivariate Cox hazards models.
HR: hazard ratio; CI: confidence interval; HD: hemodialysis; NMBA: neuromuscular blocking agents; SOFA: Sequential Organ Failure Assessment.
aAll clinical data was calculated or checked from medical records on blood collection day.
Characteristics | Total (n = 161) | IDC (n = 96) | No IDC (n = 65) | P-value |
---|---|---|---|---|
Age (yr) | 66 (18–95) | 62 (20–91) | 66 (18–95) | 0.526 |
Male sex | 93 (57.8) | 56 (58.3) | 37 (56.7) | 0.872 |
APACHE II score |
18 (5–38) | 16 (5–34) | 20 (8–38) | <0.001 |
SOFA score |
8 (2–20) | 7 (2–20) | 9 (2–17) | 0.020 |
ICU LOS (day) | 23 (1–430) | 34 (2–430) | 16 (1–177) | 0.003 |
Hospital LOS (day) | 43 (2–431) | 58 (10–431) | 21 (2–422) | <0.001 |
Total MV (day) | 19 (1–430) | 23 (1–430) | 12 (1–118) | 0.012 |
Comorbidity | ||||
Diabetes | 46 (28.6) | 28 (29.2) | 18 (27.7) | 0.861 |
Cardiovascular disease | 37 (23.0) | 19 (19.8) | 18 (27.7) | 0.258 |
Hemato-oncologic disease | 35 (21.7) | 11 (11.5) | 24 (36.9) | <0.001 |
Cerebrovascular disease | 27 (16.8) | 18 (18.8) | 9 (13.8) | 0.520 |
Chronic kidney disease | 22 (13.7) | 14 (14.6) | 8 (12.3) | 0.816 |
Chronic lung disease |
17 (10.6) | 11 (11.5) | 6 (9.2) | 0.796 |
Chronic liver disease | 14 (8.7) | 9 (9.4) | 5 (7.7) | 0.783 |
Neuromuscular disease | 13 (8.1) | 8 (8.3) | 5 (7.7) | >0.999 |
Source of infection |
||||
Respiratory | 76 (47.2) | 48 (50.0) | 28 (43.1) | 0.424 |
Catheter-related | 43 (26.7) | 35 (36.5) | 8 (12.3) | 0.001 |
Musculoskeletal and soft tissue | 26 (16.1) | 20 (20.8) | 6 (9.2) | 0.053 |
Intra-abdomen | 12 (7.5) | 6 (6.3) | 6 (9.2) | 0.548 |
Urinary tract | 5 (3.1) | 3 (3.1) | 2 (3.1) | >0.999 |
ICU type | ||||
Medical | 65 (40.4) | 34 (35.4) | 31 (47.7) | 0.142 |
Surgical | 17 (10.6) | 10 (10.4) | 7 (10.8) | >0.999 |
Emergency | 40 (24.8) | 23 (24.0) | 17 (26.2) | 0.853 |
Neurosurgical | 18 (11.2) | 11 (11.5) | 7 (10.8) | >0.999 |
Cardio-stroke | 8 (5.0) | 5 (5.2) | 3 (4.6) | >0.999 |
Trauma | 13 (8.1) | 13 (13.5) | 0 | 0.001 |
Bacteria | ||||
Methicillin-resistant Staphylococcus aureus | 59 (36.6) | 36 (37.5) | 23 (35.4) | 0.868 |
Carbapenem-resistant Acinetobacter baumannii | 59 (36.6) | 37 (38.5) | 22 (33.8) | 0.618 |
Vancomycin-resistant Enterococcus faecium | 20 (12.4) | 11 (11.5) | 9 (13.8) | 0.808 |
ESBL(+) Klebsiella pneumoniae | 18 (11.2) | 11 (11.5) | 7 (10.8) | >0.999 |
ESBL(+) Escherichia coli | 9 (5.6) | 5 (5.2) | 4 (6.2) | >0.999 |
Carbapenem-resistant Pseudomonas aeruginosa | 5 (3.1) | 2 (2.1) | 3 (4.6) | 0.394 |
Period from ICU admission to bacteremia (day) | 9 (0–413) | 10 (0–413) | 7 (0–366) | 0.554 |
Administration of the first recommended antibiotics |
120 (74.5) | 85 (88.5) | 35 (53.8) | <0.001 |
Period of administration of the first recommended antibiotics (day) |
||||
Before microorganisms identification | 0 (0–55) | 0 (0–25) | 0 (0–55) | 0.979 |
After microorganisms identification | 7 (0–116) | 14 (0–116) | 0 (0–33) | <0.001 |
Requirement for vasopressor |
82 (50.9) | 39 (40.6) | 43 (66.2) | 0.002 |
Requirement of hemodialysis |
44 (27.3) | 20 (20.8) | 24 (36.9) | 0.031 |
Requirement for neuromuscular blocking agent |
39 (24.2) | 19 (19.8) | 20 (30.8) | 0.134 |
28-Day mortality | 84 (52.2) | 37 (38.5) | 47 (72.3) | <0.001 |
Antibiotics | Total (n = 161) | IDC (n = 96) | No IDC (n = 65) | P-value |
---|---|---|---|---|
Glycopeptide | 93 (57.5) | 54 (56.3) | 39 (60.0) | 0.745 |
Carbapenem | 76 (47.2) | 40 (41.7) | 36 (55.4) | 0.108 |
Fluoroquinolone | 75 (46.6) | 46 (47.9) | 29 (44.6) | 0.748 |
Third-generation cephalosporins | 66 (41.0) | 47 (49.0) | 19 (29.2) | 0.015 |
Anti-pseudomonal penicillin | 48 (29.8) | 29 (30.2) | 19 (29.2) | >0.999 |
Fourth generation cephalosporins | 34 (21.1) | 22 (22.9) | 12 (18.5) | 0.559 |
Colistin | 32 (19.9) | 12 (12.5) | 4 (6.2) | 0.283 |
Aminoglycoside | 16 (9.9) | 12 (12.5) | 4 (6.2) | 0.283 |
Minocycline | 13 (8.1) | 10 (10.4) | 3 (4.6) | 0.244 |
Macrolides | 9 (5.6) | 5 (5.2) | 4 (6.2) | >0.999 |
Second generation cephalosporins | 6 (3.7) | 6 (6.3) | 0 | 0.082 |
Trimethoprim-sulfamethoxazole | 6 (3.7) | 4 (4.2) | 2 (3.1) | >0.999 |
Linezolid | 5 (3.1) | 2 (2.1) | 3 (4.6) | 0.394 |
Tigecycline | 4 (2.5) | 2 (2.1) | 2 (3.1) | >0.999 |
Organism | ESBL (n = 27) |
CRPA & CRAB (n = 64) |
MRSA (n = 59) |
VRE (n = 20) |
||||
---|---|---|---|---|---|---|---|---|
IDC (n = 16) | No IDC (n = 11) | IDC (n = 39) | No IDC (n = 25) | IDC (n = 36) | No IDC (n = 23) | IDC (n = 11) | No IDC (n = 9) | |
Glycopeptide | 6 (37.5) | 4 (36.4) | 13 (33.3) | 10 (40.0) | 30 (83.3) | 19 (82.6) | 1 (9.1) |
5 (55.6) |
Carbapenem | 16 (100) |
5 (45.5) |
13 (33.3) | 12 (48.0) | 9 (25.0) | 6 (26.1) | 1 (9.1) | 7 (77.8) |
Fluoroquinolone | 1 (6.3) | 4 (36.4) | 1 (2.6) |
8 (32.0) |
5 (13.9) | 4 (17.4) | 1 (9.1) | 1 (11.1) |
Third-generation cephalosporins | 0 | 11 (18.2) | 1 (2.6) |
7 (28.0) |
5 (13.9) | 3 (13.0) | 0 | 0 |
Anti-pseudomonal penicillin | 0 | 2 (18.2) | 3 (7.7) | 2 (8.0) | 4 (11.1) | 3 (13.0) | 0 | 0 |
Fourth generation cephalosporins | 0 | 0 | 2 (5.1) | 2 (8.0) | 10 (27.8) | 4 (17.4) | 1 (9.1) | 0 |
Colistin | 5 (31.3) | 1 (9.1) | 32 (82.1) |
13 (52.0) |
8 (22.2) | 2 (8.7) | 2 (18.2) | 1 (11.1) |
Aminoglycoside | 0 | 0 | 1 (2.6) | 1 (4.0) | 1 (2.8) | 0 | 0 | 0 |
Minocycline | 5 (31.3) | 0 | 15 (38.5) |
2 (8.0) |
1 (2.8) | 2 (8.7) | 0 | 1 (11.1) |
Macrolide | 0 | 0 | 3 (7.7) | 2 (8.0) | 1 (2.8) | 0 | 0 | 0 |
Second generation cephalosporins | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Trimethoprim-sulfamethoxazole | 0 | 0 | 1 (2.6) | 1 (4.0) | 0 | 0 | 0 | 1 (11.1) |
Linezolid | 1 (6.3) | 1 (9.1) | 0 | 1 (4.0) | 3 (8.3) | 2 (8.7) | 7 (63.6) | 3 (33.3) |
Tigecycline | 0 | 1 (9.1) | 3 (7.7) | 0 | 0 | 1 (4.3) | 1 (9.1) | 0 |
Factor | Univariate analysis |
Multivariate analysis |
||
---|---|---|---|---|
HR (95% CI) | P-value | HR (95% CI) | P-value | |
Total patients | ||||
Infectious disease consultation | 0.325 (0.210–0.502) | <0.001 | 0.353 (0.226–0.552) | <0.001 |
Requirement for vasopressors |
3.154 (1.980–5.025) | <0.001 | 2.409 (1.483–3.914) | <0.001 |
Requirement for HD |
2.599 (1.672–4.043) | <0.001 | 1.640 (1.037–2.593) | 0.034 |
Requirement for NMBAs |
1.978 (1.248–3.314) | 0.004 | 2.357 (1.446–3.843) | 0.001 |
Thrombocytopenia |
2.298 (1.436–3.675) | 0.001 | 1.747 (1.078–2.830) | 0.023 |
Hemato-oncologic diseases as comorbidities | 2.187 (1.373–3.483) | 0.001 | - | - |
Age ≥65 yr | 1.591 (1.028–2.460) | 0.037 | - | - |
In patients with SOFA ≥9 |
||||
Infectious disease consultation | 0.313 (0.177–0.554) | <0.001 | 0.298 (0.167–0.532) | <0.001 |
Requirement for NMBAs |
1.681 (0.959–2.949) | 0.070 | 1.834 (1.033–3.256) | 0.038 |
Requirement for vasopressors |
1.968 (0.958–4.041) | 0.065 | - | - |
Requirement for HD |
1.837 (1.065–3.169) | 0.029 | - | - |
In patients with gram-negative bacteremia | ||||
Infectious disease consultation | 0.203 (0.114–0.361) | <0.001 | 0.180 (0.097–0.333) | <0.001 |
Requirement for vasopressors |
3.178 (1.733–5.831) | <0.001 | 3.168 (1.670–6.010) | <0.001 |
Requirement for HD |
3.047 (1.753–5.298) | <0.001 | 2.607 (1.473–4.614) | 0.001 |
Requirement for NMBAs |
2.226 (1.249–3.969) | 0.007 | 1.879 (1.025–3.446) | 0.041 |
Thrombocytopenia |
1.722 (0.932–3.183) | 0.083 | - | - |
Hemato-oncologic diseases as comorbidities | 1.648 (0.929–2.922) | 0.087 | - | - |
Values are presented as median (range) for continuous variables or number (%) for categorical variables. IDC: infectious disease consultation; APACHE: Acute Physiology and Chronic Health Evaluation; SOFA: Sequential Organ Failure Assessment; ICU: intensive care unit; LOS: length of stay; MV: mechanical ventilation; ESBL: extended-spectrum beta-lactamases. All clinical data was calculated or checked from medical records on blood collection day; Chronic lung diseases included chronic obstructive pulmonary disease, asthma and bronchiectasis; Of total patients, 24 patients had more than two sources of infection; The first recommended antibiotics were known as “drug of choice” and were summarized as follows: methicillin-resistant
Values are presented as number (%). IDC: infectious disease consultation.
Values are presented as number (%). IDC: infectious disease consultation; ESBL: extended-spectrum β-lactamase; CRPA: carbapenem-resistant In the chi-square or Fisher exact tests (for small numbers), significance was defined as P < 0.05.
Statistical significance was tested by univariate Cox proportional hazards models and multivariate Cox hazards models. HR: hazard ratio; CI: confidence interval; HD: hemodialysis; NMBA: neuromuscular blocking agents; SOFA: Sequential Organ Failure Assessment. All clinical data was calculated or checked from medical records on blood collection day.