Clinical Outcomes of Patients in the Intensive Care Unit with Infections Caused By Multiresistant Gram-Negative Bacteria in Colombian Patients

OBJECTIVES: To describe the clinical outcomes in patients in the intensive care unit (ICU) with infections caused by multiresistant Gram-negative bacteria.

METHODS: This study is an observational, retrospective study in Colombian ICU patients from two hospitals between 2018 to 2021. Patients with diagnosis of bacteremia, urinary tract, pneumonia, and intra-abdominal with confirmed resistant Gram-negative bacteria were included. The index date was the date of diagnosed with an infection reported in the medical records. Patients were followed up until 30 days in the hospital, discharge, or death. Clinical outcomes included were in-hospital mortality, length-of-stay (LoS) in ICU and mechanical ventilation (MV). Multivariable-analysis was performed to evaluate the relationships between demographic, clinical and treatment characteristics.

RESULTS: One hundred sixty-two patients were included in the study but only 152 patients had information about treatments used. Included patients tended to be older adults, the mean age was 59.1 (Standard deviation (SD) 16.1) mainly men (59.9%). The mean APACHE II score at the admission in ICU was 40.8 (SD 23.86). The main etiological causes of infection were K. pneumoniae (45.0%), E. coli (13.6%), P. aeruginosa (12.3%), and Enterobacter spp. (9.8). Carbapenemases were reported in 83.3% of cases. The mortality was reported in 40.7% of patients. The mean time in ICU was 27.6±33.5 days. MV was required in 132 patients and the mean time in MV was 23.8±32.6 days. The clinical outcomes were influenced by age, SOFA, APACHE II, Pitt score, type of resistance, colonization and previous ICU hospitalization, septic shock, use of central venous catheter, and etiology. The use of empiric treatment increased the mortality and decreased the LoS of UCI, but it was not statistically significant.

CONCLUSIONS: The mortality of ICU patients with infections caused by multiresistant Gram-negative bacteria reported high frequency and long LoS of ICU and VM, however, clinical and treatment characteristics can modify these outcomes.