Prevalence and predictors of confirmed infection in patients receiving empiric antimicrobials in the intensive care unit: a retrospective cohort study
Prevalência e preditores de infecção confirmada em pacientes recebendo antimicrobianos empíricos na unidade de terapia intensiva: um estudo de coorte retrospectivo
Luis Carlos Maia Cardozo Junior; Larissa Bianchini; Jakeline Neves Giovanetti; Luiz Marcelo Almeida de Araujo; Yuri de Albuquerque Pessoa dos Santos; Bruno Adler Maccagnan Pinheiro Besen; Marcelo Park
Abstract
Background
Infection diagnosis in Intensive Care Units (ICUs) is a challenge given the spectrum of conditions that present with systemic inflammation, the illness severity and the delay and
imprecision of existing diagnostic methods. We hence sought to analyze the prevalence and predictors of confirmed infection after empirical antimicrobials during ICU stay.
Methods
Retrospective cohort of prospectively collected ICU data in an academic tertiary hospital in Sao Paulo, Brazil. We included all adult patients given a new empirical antimicrobial during their ICU stay. We excluded patients using prophylactic or microbiologically guided antimicrobials. Primary outcome was infection status, defined as confirmed, probable, possible, or discarded. In a multivariable analysis, we explored variables associated with confirmed infection.
Results
Out of After screening 1721 patients admitted to the ICU from November 2017 to November 2022, we identified 398 new antimicrobial prescriptions in 341 patients. After exclusions, 243 antimicrobial prescriptions for 206 patients were included. Infection was classified as confirmed in 61 (25.1%) prescriptions, probable in 39 (16.0%), possible in 103 (42.4%), and discarded in 40 (16.5%). The only factor associated with infection was deltaSOFA (OR = 1.18, 95% CI 1.02 to 1.36, p = 0.022).
Conclusions
Suspected infection in the ICU is frequently not confirmed. Clinicians should be aware of the need to avoid premature closure and revise diagnosis after microbiological results.
Development and implementation of new tools for faster infection diagnosis and guiding of antimicrobial prescription should be a research priority.
Keywords
Resumo
Introdução
O diagnóstico de infecção em Unidades de Terapia Intensiva (UTIs) é um desafio, dado o espectro de condições que se apresentam com inflamação sistêmica, a gravidade da doença e o atraso e imprecisão dos métodos diagnósticos existentes. Portanto, buscamos analisar a prevalência e os preditores de infecção confirmada após antimicrobianos empíricos durante a internação na UTI.
Métodos
Coorte retrospectiva de dados coletados prospectivamente na UTI em um hospital terciário acadêmico em São Paulo, Brasil. Incluímos todos os pacientes adultos que receberam um novo antimicrobiano empírico durante sua internação na UTI. Excluímos pacientes em uso de antimicrobianos profiláticos ou guiados microbiologicamente. O desfecho primário foi o estado da infecção, definido como confirmado, provável, possível ou descartado. Em uma análise multivariável, exploramos variáveis associadas à infecção confirmada.
Resultados
Após a triagem de 1.721 pacientes admitidos na UTI de novembro de 2017 a novembro de 2022, identificamos 398 novas prescrições de antimicrobianos em 341 pacientes. Após as exclusões, 243 prescrições de antimicrobianos para 206 pacientes foram incluídas. A infecção foi classificada como confirmada em 61 (25,1%) prescrições, provável em 39 (16,0%), possível em 103 (42,4%) e descartada em 40 (16,5%). O único fator associado à infecção foi o deltaSOFA (OR = 1,18, IC 95% 1,02 a 1,36, p = 0,022).
Conclusão
A suspeita de infecção na UTI frequentemente não é confirmada. Os clínicos devem estar cientes da necessidade de evitar o fechamento prematuro e revisar o diagnóstico após os resultados microbiológicos. O desenvolvimento e a implementação de novas ferramentas para diagnóstico mais rápido de infecções e orientação da prescrição antimicrobiana devem ser uma prioridade de pesquisa.
Palavras-chave
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Submitted date:
03/21/2024
Accepted date:
10/09/2024
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