EMPIRICAL THERAPY OF BLOODSTREAM INFECTION IN UNIVERSITY HOSPITAL

Resumo

The primary bloodstream infections (BSI) are important causes of morbidity and mortality in developing countries, due to severity of the disease and inadequate empirical therapeutical regimens.

The main objective of this pilot study was to retrospectively assess appropriateness of prescribing antibiotics for treating laboratory-confirmed BSI in two intensive care units (ICU) located in a large university hospital, according to susceptibility profile of the isolated agents.

During the study period (January 1^st, 2011 to August 31^st, 2012) a total of 47 patients had laboratory-confirmed BSI, and 57 pathogens were isolated in blood cultures. Twenty-two patients (47%) were female and 25 male (53%),  mean age of 58 years (range 23-84). Regarding types of patients, 19 (40%) suffered from clinical conditions and 28 (60%) underwent surgical procedures. The mean time to initiate empirical treatment was 38 hours, with no statistically significant difference in patient type. Empirical treatment was considered adequate in 58% of cases, inappropriate in 23%, and was not started before culture results in 19%, with no statistically significant difference between patient types. Of the 57 pathogens isolated from blood cultures, 42 (74%) were Gram-negative and 15 (26%) Gram-positive, and the most prevalent agent was Acinetobacter baumannii (n=18; 31.6%), followed by Klebsiella pneumoniae (n=5; 8.8%), Pseudomonas aeruginosa (n=5; 8.8%), Serratia marcescens (n=5; 8.8%) and coagulase-negative staphylococci (n=5; 8.8%). Staphylococcus aureus was isolated in only 7% of the samples. As for multidrug resistance, the overall percentage was 53% (30/57), and Acinetobacter baumannii (78% - 14/18), Pseudomonas aeruginosa (60% - 3/5) and S. aureus (100%, 4/4) presented the lowest sensitivity profile.

Thus, a larger prospective study is suggested to confirm these preliminary data. The final results may be used to guide the revision of treatment protocols and intensification of preventive measures.