Bacterial bloodstream infections in level-I trauma intensive care unit in Serbia: incidence, causative agents and outcomes

  • Olivera Djuric University of Belgrade, Belgrade, Serbia https://orcid.org/0000-0002-8574-5938
  • Ljiljana Markovic-Denic University of Belgrade, Belgrade, Serbia
  • Bojan Jovanovic Clinical Centre of Serbia, Belgrade, Serbia
  • Snezana Jovanovic Clinical Centre of Serbia, Belgrade, Serbia
  • Vuk Marusic University of Belgrade, Belgrade, Serbia
  • Vesna Bumbasirevic Clinical Centre of Serbia, Belgrade, Serbia
Keywords: bloodstream infections, healthcare-associated infections, trauma, outcome, antimicrobial resistance

Abstract

Introduction: We aimed to describe incidence, outcomes and antimicrobial resistance markers of causative agents of bacterial BSI in the intensive care unit (ICU) in a trauma center in Serbia.

Methodology: Prospective surveillance was conducted from November 2014 to April 2016 in two trauma-surgical ICUs of the Emergency Department of Clinical center of Serbia. Bloodstream infections were diagnosed using the definitions of Center for Disease Control and Prevention.

Results: Out of 406 trauma patients, 57 had at least one episode of BSI (cumulative incidence 14.0%). Overall 62 BSI episodes were diagnosed (incidence rate 11.8/1000 patient/days), of which 43 (69.4%) were primary BSI (13 catheter-related BSI and 30 of unknown origin) and 19 (30.6%) were secondary BSI. The most common isolated pathogen was Acinetobacter spp. [n = 24 (34.8%)], followed by Klebsiella spp. [n = 17 (24.6%)] and P. aeruginosa [n = 8 (1.6%)]. All S. aureus [n = 6 (100%)] and CoNS [n = 3 (100%)] isolates were methicillin resistant, while 4 (66%) of Enterococci isolates were vacomycin resistant. All isolates of Enterobacteriaceae were resistant to third-generation cephalosporins [n = 22 (100%)] while 7 (87.5%) of P. aeruginosa and 23 (95.8%) of Acinetobacter spp. isolates were resistant to carbapenems. All-cause mortality and sepsis were significantly higher in trauma patients with BSI compared to those without BSI (P < 0.001 each).

Conclusions: BSI is a common healthcare-associated infection in trauma ICU and it is associated with worse outcome. Better adherence to infection control measures and guidelines for prevention of primary BSI must be achieved.

Author Biographies

Olivera Djuric, University of Belgrade, Belgrade, Serbia

Research assistant and PhD candidate at Institute of Epidemiology, Faculty of Medicine, University of Belgrade

Ljiljana Markovic-Denic, University of Belgrade, Belgrade, Serbia

Institute of Epidemiology, Faculty of Medicine

Bojan Jovanovic, Clinical Centre of Serbia, Belgrade, Serbia

Centre for Anaesthesiology

Snezana Jovanovic, Clinical Centre of Serbia, Belgrade, Serbia

Department of Microbiology

Vuk Marusic, University of Belgrade, Belgrade, Serbia

Institute of Epidemiology, Faculty of Medicine

Vesna Bumbasirevic, Clinical Centre of Serbia, Belgrade, Serbia

Centre for Anaesthesiology

Published
2018-12-31
How to Cite
1.
Djuric O, Markovic-Denic L, Jovanovic B, Jovanovic S, Marusic V, Bumbasirevic V (2018) Bacterial bloodstream infections in level-I trauma intensive care unit in Serbia: incidence, causative agents and outcomes. J Infect Dev Ctries 12:1079-1087. doi: 10.3855/jidc.10737
Section
Original Articles