Bloodstream infections in intensive care unit patients: distribution and antibiotic resistance of bacteria.
Infect Drug Resist. 2015 Aug 10;8:287-96.
Russotto V1, Cortegiani A1, Graziano G2, Saporito L2, Raineri SM1, Mammina C2, Giarratano A1.
1Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Paolo Giaccone University Hospital, University of Palermo, Palermo, Italy.
2Department of Sciences for Health Promotion and Mother-Child Care, University of Palermo, Palermo, Italy.
Bloodstream infections (BSIs) are among the leading infections in critically ill patients. The case-fatality rate associated with BSIs in patients admitted to intensive care units (ICUs) reaches 35%-50%.
The emergence and diffusion of bacteria with resistance to antibiotics is a global health problem. Multidrug-resistant bacteria were detected in 50.7% of patients with BSIs in a recently published international observational study, with methicillin resistance detected in 48% of Staphylococcus aureus strains, carbapenem resistance detected in 69% of Acinetobacter spp., in 38% of Klebsiella pneumoniae, and in 37% of Pseudomonas spp.
Prior hospitalization and antibiotic exposure have been identified as risk factors for infections caused by resistant bacteria in different studies.
Patients with BSIs caused by resistant strains showed an increased risk of mortality, which may be explained by a higher incidence of inappropriate empirical therapy in different studies.
The molecular genetic characterization of resistant bacteria allows the understanding of the most common mechanisms underlying their resistance and the adoption of surveillance measures.
Knowledge of epidemiology, risk factors, mechanisms of resistance, and outcomes of BSIs caused by resistant bacteria may have a major influence on global management of ICU patients.
The aim of this review is to provide the clinician an update on BSIs caused by resistant bacteria in ICU patients.