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Infections in critically ill patients: Experience in MICU at a major teaching hospital

Infektionen bei schwerkranken Patienten; Erfahrungen in der medizinischen Intensivpflegestation eines größeren Lehrkrankenhauses

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Summary

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. andStreptococcus 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.

Zusammenfassung

Während eines Jahres traten bei 105 Patienten einer medizinischen Intensivpflegestation 134 Infektionen auf, die im Rahmen einer prospektiven Studie analysiert wurden. Es handelte sich um 54 Männer und 51 Frauen im Alter von 14 bis 100 Jahren (Median 54 Jahre). Die Gesamtinzidenz an Infektionen betrug 46,7%. 47,8% der Infektionen wurden auf der Inneren Station erworben, 27% waren nicht nosokomiale Infektionen und 25,2% waren auf der Intensivpflegestation erworben. Die häufigsten Infektionen waren Pneumonien und Septikämien, die insgesamt 88% der Fälle ausmachten. Harnwegsinfektionen (4,4%), Infektionen des Gastrointestinaltraktes (5%) und Haut- und Wundinfektionen (2,5%) machten zusammen nur 11,5% der Fälle aus. Die häufigsten Erreger waren gramnegative Stäbchen,Staphylococcus spp., undStreptococcus pneumoniae. Bei den nicht nosokomialen Infektionen dominierten gramnegative Stäbchenbakterien.Mycobacterium tuberculosis erwies sich zusätzlich als wichtiger Erreger der Pneumonie bei diesen Patienten. Die meisten Patienten hatten eine Monoinfektion; in 11,9% der Fälle wurde eine polymikrobielle Infektion nachgewiesen. Die Mortalität der Gesamtgruppe lag bei 46,7%. Verschiedene Faktoren, die die Mortalität bei diesen Patienten beeinflussen, wurden analysiert. Bei rechtzeitiger Erkennung dieser Faktoren kann es gelingen, die Morbidität und Mortalität zu senken.

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Authors and Affiliations

  1. Depts. of Pulmonary Critical Care Medicine, Pharmacy and Microbiology, College of Medicine and King Khalid University Hospital, Riyadh, Saudi Arabia

    N. S. Dahmash M. D., S. C. Arora (M. R. C. P.), D. F. Fayed Pharm. D. &  M. N. H. Chowdhury M. B. B. S., Ph. D. (FRC Path.)

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  1. N. S. Dahmash M. D.
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  2. S. C. Arora
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  3. D. F. Fayed Pharm. D.
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  4. M. N. H. Chowdhury M. B. B. S., Ph. D.
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Dahmash, N.S., Arora, S.C., Fayed, D.F. et al. Infections in critically ill patients: Experience in MICU at a major teaching hospital. Infection 22, 264–270 (1994). https://doi.org/10.1007/BF01739913

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