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Bloodstream Infections in the Intensive Care Unit: a Single-Center Retrospective Bacteriological Analysis Between 2007 and 2019

Aneta Guzek
Aneta Guzek
, 
Zbigniew Rybicki
Zbigniew Rybicki
, 
Agnieszka Woźniak-kosek
Agnieszka Woźniak-kosek
 et 
Dariusz Tomaszewski
Dariusz Tomaszewski
   | 19 juin 2022
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Article Category: Original paper
Publié en ligne: 19 juin 2022
Pages: 263 - 277
Reçu: 16 févr. 2022
Accepté: 14 mai 2022
DOI: https://doi.org/10.33073/pjm-2022-025
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© 2022 Aneta Guzek et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1

Trends in pathogens isolated between 2007 and 2019.
Trends in pathogens isolated between 2007 and 2019.

Fig. 2

Gram-positive alert pathogens with mechanisms of resistance, isolated between 2009 and 2019.
Gram-positive alert pathogens with mechanisms of resistance, isolated between 2009 and 2019.

Fig. 3

Gram-negative alert pathogens with mechanisms of resistance, isolated between 2009 and 2019.
Gram-negative alert pathogens with mechanisms of resistance, isolated between 2009 and 2019.

Descriptive statistics of the study population and their primary diagnoses according to ICD10.

Year
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Patients n 197 182 216 173 224 178 172 186 350 422 422 450 348
Age median 53 54 60 59 49 43 45 49 43 43 52 57 53
minimum 18 18 18 21 19 18 18 15 19 18 19 21 24
maximum 84 86 87 87 82 87 82 91 87 85 87 85 88
Q1-Q3 42-69 29-74 42-71 44-75 37-65 28-59 28-67 37-62 27-63 29-57 40-67 38-69 37-63
Hospitalization time in ICU (days) median 22 26 16 30 17 20 23 14 16 15 14 14 8
minimum 1 1 1 1 1 1 1 1 1 1 1 1 1
maximum Q1-Q3 136 11–47 147 9-48 124 7-27 137 11–58 48 5-27 107 11-31 106 10-36 273 8-39 126 8–31 275 7-35 205 5-36 159 5-32 238 24
Deaths n (%) 71 (36%) 62 (34%) 68 (31%) 57 (33%) 83 (37%) 60 (34%) 56 (33%) 64 (34%) 135(39%) 117(28%) 166 (39%) 160 (36%) 149 (43%)
Main diagnosis according to ICD10
Year
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Other bacterial diseases [A30–A49]1 4 4 6 3 6 3 4 4 8 11 13 12 10
Malignant [C00–C14]neoplasms 2 of lip, oral cavity, and pharynx 3 5 3 4 4 3 4 3 4 4 3 5 4
Malignant neoplasms of digestive organs [C15–C26]3 0 1 2 0 0 0 0 0 0 1 0 0 0
Malignant organs [C30neoplasms –C39]4 of respiratory and intrathoracic 0 0 1 0 0 0 0 0 1 1 0 0 0
Malignant and related neoplasms tissue [C81of -lymphoid, C96]5 hematopoietic, 4 3 4 4 4 4 3 4 7 8 6 6 5
Diabetes mellitus [E10-E14]6 4 7 5 4 5 3 2 4 6 5 7 6 5
Obesity and other hyperalimentation [E65-E68] 0 0 1 0 1 0 0 0 2 2 3 3 1
Metabolic disorders7 4 2 3 0 1 0 1 1 3 0 3 4 2
Inflammatory system [G00–Gdiseases 09]8 of the central nervous 3 1 2 0 4 0 0 0 2 2 3 4 2
Systemic nervous system atrophies [Gprimarily 10–G14]9 affecting the central 0 0 1 0 0 0 0 0 0 0 0 0 0
Episodic and paroxysmal disorders [G40–G47]10 2 3 2 0 1 0 0 1 1 2 1 2 2
Diseases [G70–G73of ]myoneural 11 junction and muscle 0 0 1 1 0 0 0 0 0 1 0 0 0
Cerebral [G80–G83palsy ]12 and other paralytic syndromes 0 2 0 0 0 0 0 0 0 0 0 0 0
Other disorders of the nervous system [G90–G99]13 0 0 0 0 0 0 0 0 2 1 0 0 0
Ischemic heart diseases [I20–I25]14 3 3 4 0 3 2 2 2 4 6 6 5 4
Pulmonary circulation heart [I26–Idisease 28]15 and diseases of pulmonary 2 1 2 0 2 2 2 3 6 7 8 8 6
Other forms of heart disease [I30–I52]16 36 27 25 13 27 17 16 17 24 31 27 34 28
Cerebrovascular diseases [I60–I69]17 6 8 10 0 10 8 8 8 14 13 14 22 16
Diseases of arteries, arterioles, and capillaries [I70–I79]18 4 2 2 0 0 0 0 0 2 1 1 0 0
Diseases nodes [I80of –veins, I89]19 lymphatic vessels, and lymph 1 0 0 0 0 0 0 0 0 0 1 0 0
Influenza and pneumonia [J09-J18]20 1 0 3 5 5 3 2 2 5 6 6 6 4
Chronic lower respiratory diseases [J40–J47]21 7 7 9 10 9 8 8 9 16 19 18 21 18
Lung diseases due to external agents [J60–J70]22 5 4 5 0 2 2 1 1 1 3 3 4 2
Other the interstitium respiratory [Jdiseases 80–J84)23 principally affecting 5 1 5 6 6 4 3 3 3 5 5 4 3
Suppurative respiratory tract and necrotic [J85–J86conditions ]24 of the lower 0 1 0 0 0 0 0 0 0 2 0 1 0
Other diseases of the respiratory system [J95–J99]25 21 10 19 44 38 28 22 19 25 30 28 37 27
Diseases [K20–K31of ]esophagus, 26 stomach, and duodenum 5 4 4 2 2 2 1 0 2 4 5 6 0
Hernia [K40–K46]27 0 0 1 1 2 0 0 0 1 1 0 0 2
Other diseases of the intestines [K55-K64]28 0 0 1 2 1 1 0 0 2 3 4 3 1
Diseases of peritoneum [K65–K67]29 5 8 10 11 13 9 11 9 16 16 14 16 10
Diseases of the liver [K70–K77]30 0 0 1 0 0 1 0 1 2 2 3 3 0
Disorders [K80–K87of ]31 gallbladder, biliary tract, and pancreas 13 10 10 13 14 9 8 9 11 9 7 10 6
Other diseases of the digestive system [K90–K93]32 0 0 0 0 0 0 1 1 0 0 3 2 0
Infections [L00–L08]of 33 the skin and subcutaneous tissue 0 0 0 0 0 1 0 0 0 0 0 0 0
Systemic connective tissue disorders [M30 -M32]34 0 0 0 0 0 0 0 0 0 1 0 0 0
Osteopathies and chondropathies [M80–M94]35 0 0 0 0 0 0 0 0 0 0 0 1 0
Injuries to the head [S00–S09]36 5 5 7 9 9 8 11 9 27 23 23 24 16
Injuries to the neck [S10–S19]37 0 0 0 4 0 2 3 0 2 0 0 2 0
Injuries to the thorax [S20–S29]38 4 3 3 2 0 2 0 4 7 3 8 4 2
Injuries and pelvis to the [S30abdomen, –S39]39 lower back, lumbar spine, 2 3 3 4 4 2 0 2 10 17 23 17 9
Injuries to the shoulder and upper arm [S40–S49]40 0 0 0 0 0 1 0 0 0 1 0 0 0
Injuries to the hip and thigh [S70–S79]41 0 0 0 0 0 0 0 0 2 2 0 0 2
Injuries to the knee and lower leg [S80–S89]42 0 0 1 0 0 0 0 0 0 2 0 1 0
Injuries involving multiple body regions [T00–T07]43 44 45 53 21 32 41 48 57 101 142 145 141 134
Burns and corrosions [T20–T32]44 4 9 6 9 16 10 11 11 19 31 29 35 26
Poisoning substances by [Tdrugs, 36–T50medicaments, ]45 and biological 0 2 1 1 2 2 0 2 1 3 2 1 0
Other [T66-Tand 78]unspecified 46 effects of external causes 0 1 0 0 1 0 0 0 1 1 0 0 1

The number of microbiological analyses, with their results, performed between 2007 and 2019.

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Beds in ICU (n) 8 8 8 8 8 8 8 14 18 18 18 18 18
Hospitalizations (n) 179 182 216 173 224 178 172 186 350 422 422 450 348
Microbiological analyses (n) 2,361 2,349 2,710 2,454 3,123 2,796 2,797 2,811 4,093 5,376 5,030 5,089 5,264
Microbiological of blood samples analyses (n) 670 613 785 641 1,245 1,016 944 831 1,219 1,326 988 1,161 1,180
Blood analyses, microbiological negative results (n) 548 473 632 534 1,130 889 809 690 1,064 1,140 858 1,023 994
Blood analyses, microbiological positive results (n) 107 120 135 97 104 99 106 112 120 154 104 106 145
Blood microbiological analyses, contaminated samples (n) 15 20 18 10 11 28 29 29 35 32 26 32 41
Microbiological of the tip of the analyses catheter (n) 30 23 28 18 39 29 45 53 70 70 76 77 65
Microbiological analyses of the tip of the catheter, positive results (n) 13 11 17 12 21 11 31 30 20 29 31 26 26

The number of pathogens isolated from blood samples between 2007 and 2019.

Pathogen (mechanism of Pathogen antibiotic resistance) 2007 2008 2009 2010 2011 2011 2012 2013 2014 2015 2016 2017 2018 Total
Gram-negative bacilli Acinetobacter baumannii 33 24 22 19 38 26 25 29 18 26 20 18 14 312
Pseudomonas aeruginosa 9 12 9 12 7 5 7 6 8 8 9 6 11 109
Pseudomonas aeruginosa (MBL) 0 0 0 0 0 0 1 0 0 1 0 0 0 2
Stenotrophomonas maltophila 0 0 4 0 1 1 2 2 4 7 4 0 1 26
Klebsiella pneumoniae 6 8 5 2 4 2 4 9 7 14 6 8 13 88
Klebsiella pneumoniae (ESBL) 11 8 3 3 2 4 1 10 7 7 4 5 2 67
Klebsiella pneumoniae (NDM) 0 0 0 0 0 0 0 0 0 0 2 1 2 5
Klebsiella pneumoniae (KPC) 0 4 0 0 0 0 0 0 0 0 0 0 0 4
Klebsiella pneumoniae (OXA 48) 0 0 0 0 0 0 0 0 0 0 0 0 1 1
Escherichia coli 1 3 2 0 3 3 4 6 4 9 7 11 5 58
Escherichia coli (ESBL) 0 2 0 0 0 0 0 0 0 2 3 3 1 11
Enterobacter cloacae 1 0 1 0 1 1 3 3 2 5 5 7 5 34
Enterobacter cloacae (ESBL) 0 0 1 1 0 0 0 1 0 2 0 2 0 7
Proteus mirabilis 0 1 0 0 0 2 2 2 1 3 3 3 4 21
Proteus mirabilis (ESBL) 4 3 0 0 0 0 0 0 0 0 2 0 0 9
Morganella morgani 0 0 0 0 0 0 1 1 1 1 2 0 2 8
Serratia marcescens 0 0 0 0 0 0 1 1 0 2 2 0 2 8
Gram-positive cocci Staphylococcus aureus 1 5 1 3 7 3 3 3 4 4 4 9 18 65
Staphylococcus aureus (MRSA) 3 7 15 3 5 4 2 3 7 3 2 4 0 58
Coagulase-Staphylococcus negative (CNS) 2 2 5 3 2 2 6 4 6 12 5 1 4 54
Coagulase-negative Staphylococcus (MRCNS) 31 25 34 35 22 34 35 23 38 28 18 15 30 368
Enterococcus faecalis 5 8 15 5 5 5 4 5 6 16 2 6 13 95
Enterococcus faecalis (HLAR) 0 3 9 0 3 0 0 0 1 2 0 0 2 20
Enterococcus faecium 1 2 9 5 1 2 1 0 4 3 0 2 7 37
Enterococcus faecium (VRE) 0 1 0 1 0 0 1 1 0 1 2 3 1 11
Enterococcus faecium (HLAR) 1 1 1 6 1 2 1 1 1 1 0 3 2 21
Streptococcus pneumoniae 0 0 0 0 0 0 0 0 0 0 1 1 1 3
Neisseria meningitidis 1 0 0 0 0 0 0 0 0 0 0 0 0 1
Fungi Candida albicans 5 3 4 5 2 4 1 1 2 1 2 1 3 34
Candida glabrata 0 1 1 0 0 0 0 0 0 0 1 0 1 4
Candida krusei 0 0 0 0 0 1 0 0 0 0 0 0 0 1
Candida tropicalis 0 0 0 0 0 0 1 0 0 0 0 0 0 1
Candida parapsilosis 0 2 0 0 0 2 1 1 3 1 1 0 3 14
Total 115 125 141 103 104 103 107 112 124 159 107 109 148 1,557

Resistance of Gram-negative pathogens to antimicrobial agents.

Antimicrobial agent Pseudomonas aeruginosa
2007 n = 9 2008 n = 12 2009 n = 9 2010 n = 12 2011 n = 7 2012 n = 5 2013 n = 7 2014 n = 6 2015 n = 8 2016 n = 8 2017 n = 9 2018 n = 6 2019 n = 11
Ceftazidime 2 4 3 0 0 0 1 0 0 2 1 0 0
Cefepime 0 3 0 0 1 1 2 0 0 3 1 0 0
Piperacillin/tazobactam 1 1 5 0 0 1 1 0 1 4 1 0 0
Gentamycin 5 4 5 1 3 2 3 0 0 4 0 0 0
Ciprofloxacin 6 3 5 0 2 2 2 2 2 5 3 2 0
Imipenem 3 2 4 4 2 1 2 0 2 5 4 3 7
Meropenem 3 0 4 3 2 1 2 0 1 4 4 3 7
Acinetobacter baumannii
2007 n = 33 2008 n = 24 2009 n = 22 2010 n = 19 2011 n = 38 2012 n = 26 2013 n = 25 2014 n = 29 2015 n = 18 2016 n = 26 2017 n = 20 2018 n = 18 2019 n = 14
Gentamycin 30 22 7 11 29 24 22 25 16 18 13 15 8
Ciprofloxacin 32 24 21 19 34 25 23 29 18 25 20 18 14
Imipenem 11 6 10 11 31 23 21 28 17 25 19 17 10
Meropenem 6 6 8 11 31 23 21 28 17 25 19 17 10
Trimethoprim-sulfamethoxazole 20 18 16 19 36 24 15 27 16 25 20 17 10
Ampicillin/sulbactam 12 12 8 12 19 3 9 20 16 nd nd nd nd
Colistin – – – – – – – – 0 0 0 0 0
Stenotrophomonas maltophila
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
n = 0 n = 0 n = 4 n = 0 n = 1 n = 1 n = 2 n = 2 n = 4 n = 7 n = 4 n = 0 n = 1
Trimethoprim-sulfamethoxazole – – 0 – 0 0 0 0 0 0 0 – 0
ESBL-negative Enterobacterales
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
n = 8 n = 12 n = 8 n = 2 n = 8 n = 9 n = 15 n = 22 n = 15 n = 34 n = 25 n = 29 n = 31
Ceftazidime 0 0 0 0 0 0 0 0 0 0 0 0 0
Cefepime 0 0 0 0 0 0 0 0 0 0 0 0 0
Ciprofloxacin 0 3 3 0 1 0 5 1 2 10 6 4 5
Gentamycin 0 2 0 0 0 0 0 0 0 2 0 2 5
Piperacillin/tazobactam 0 0 1 0 0 0 1 1 0 0 1 4 8
Trimethoprim-sulfamethoxazole 3 2 3 1 1 1 6 1 0 3 4 2 4
ESBL-positive Enterobacterales
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
n = 15 n = 13 n = 4 n = 4 n = 2 n = 4 n = 1 n = 11 n = 7 n = 11 n = 9 n = 10 n = 3
Amoxicillin/clavulanate 12 9 3 4 2 4 1 11 6 8 9 10 3
Gentamycin 10 9 3 4 2 4 1 8 7 7 6 8 2
Ciprofloxacin 13 11 4 4 2 4 1 11 7 11 9 10 3
Imipenem 4 3 0 0 0 0 0 0 0 0 2 0 0
Meropenem 0 0 0 0 0 0 0 0 0 0 0 0 0
Trimethoprim-sulfamethoxazole 13 9 2 3 1 3 1 9 5 11 9 8 3
KPC-producing Klebsiella pneumoniae
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
n = 0 n = 4 n = 0 n = 0 n = 0 n = 0 n = 0 n = 0 n = 0 n = 0 n = 0 n = 0 n = 0
Amikacin – 0 – – – – – – – – – – –
Gentamicin – 0 – – – – – – – – – – –
Tigecycline – 2 – – – – – – – – – – –
Trimethoprim-sulfamethoxazole – 4 – – – – – – – – – – –
Colistin – 0 – – – – – – – – – – –
NDM-producing Klebsiella pneumoniae
Antimicrobial agent 2007 n = 0 2008 n = 0 2009 n = 0 2010 n = 0 2011 n = 0 2012 n = 0 2013 n = 0 2014 n = 0 2015 n = 0 2016 n = 0 2017 n = 2 2018 n = 1 2019 n = 2
Amikacin – – – – – – – – – – 2 1 2
Gentamicin – – – – – – – – – – 1 1 1
Tigecycline – – – – – – – – – – 2 1 0
Trimethoprim-sulfamethoxazole – – – – – – – – – – 1 1 1
Colistin – – – – – – – – – – 0 0 0
OXA48-producing Klebsiella pneumoniae
2007 n = 0 2008 n = 0 2009 n = 0 2010 n = 0 2011 n = 0 2012 n = 0 2013 n = 0 2014 n = 0 2015 n = 0 2016 n = 0 2017 n = 0 2018 n = 0 2019 n = 1
Amikacin – – – – – – – – – – – – 0
Gentamicin – – – – – – – – – – – – 1
Tigecycline – – – – – – – – – – – – 1
Trimethoprim-sulfamethoxazole – – – – – – – – – – – – 1
Colistin – – – – – – – – – – – – 0
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