Analysis of the etiology of infection and antimicrobial resistance in chronic critically ill patients: a longitudinal study

Abstract

Background: Hospital acquired infections and sepsis play an important role both as a triggering factor for chronic critically ill [CCI] and as a common complication of this syndrome. The aim of the study is to describe the clinical progression of sepsis episodes in CCI patients in the intensive care unit [ICU] of a Brazilian public hospital.

Materials and Methods: Retrospective longitudinal study conducted from July 2022 to June 2023 in a general ICU. The convenience sample consisted of 779 patients. Demographic, clinical, and microbiological data were analyzed.

Results: The incidence of CCI was 20.9% (n=166). Septic shock on the first day of hospitalization occurred in 60.2%. The hospital mortality rate was 50%. A total of 362 episodes of infection were recorded. Ventilator-associated pneumonia [VAP], urinary tract infection (UTI), and bloodstream infection (BSI) were the most prevalent (40%, 20.7%, and 19.6%, respectively). Bacteria of the ESKAPE group - (Enterococcus spp, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp) accounted for 57% of all positive samples, showing high bacterial resistance, with a predominance of resistance to carbapenems in gram-negative bacilli.

Conclusions: The incidence of CCI at the research institution was high. Factors such as SAPS3 score, multiple infections, and diagnosis of shock or sepsis were predictors of in-hospital mortality. VAP was the most prevalent site in the recorded infection episodes. Multidrug-resistant bacteria from the ESKAPE group were found from admission, and the antimicrobial sensitivity profile of these pathogens showed increasing resistance throughout the hospital stay.