Analysis of the structure of bacteremia in patients in chronically critically ill patients undergoing treatment and rehabilitation in intensive care units

BACKGROUND: Bacteremia is a serious clinical condition that often precedes or accompanies sepsis and septic shock, which remain the leading causes of death in hospitals worldwide. Understanding the epidemiology, including the problem of antimicrobial resistance, and the principles of bacteremia treatment is critically important for improving the outcomes in chronically critically ill patients with severe brain damage.

AIM: To determine the structure of bacteremia mainly in chronically critically ill patients with severe brain damage in the intensive care units for the period from 2018 to 2024 and their sensitivity to antibiotics, identify the most common mechanisms of resistance of the leading pathogens and formulate recommendations for optimizing antimicrobial therapy for these patients.

MATERIALS AND METHODS: The study included patients with severe brain injury, mainly in chronically critically ill, who had clinically significant bacteremia. Identification of microorganisms and determination of susceptibility to antibiotics were performed on the BD Phoenix 100 automated analyzer. EUCAST criteria were used to interpret susceptibility.

RESULTS: In 292 mainly chronically critically ill patients, the top 10 leading causative agents of bacteremia included predominantly gram-negative microorganisms Klebsiella pneumoniae (40.11%), Pseudomonas aeruginosa (6.22%), Proteus/Providencia spp. (5.94%), Acinetobacter baumannii 5.37%, Serratia marcescens (4.24%), Escheriсhia coli (3.10%), Enterobacter cloacae (1.69%). During this period of time, high resistance to carbapenems was revealed in Klebsiella pneumoniae (84.29%), Pseudomonas aeruginosa (61.90%), respectively. Among gram-positive microorganisms, the leading role in the structure of bacteremia is occupied by coagulase-negative staphylococci (21.47%).

CONCLUSION: The predominant causative agents of bacteremia in mainly chronically critically ill patients in the intensive care unit were gram-negative bacteria with a high level of antibiotic resistance, including carbapenem-resistant Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii. The creation of protocols for effective empirical antimicrobial therapy is impossible without analyzing local data on antibiotic susceptibility.