Title : Risk factor and outcome analysis of gram positive bacteriemia in critically ill patients

Abstract:

Introduction
Bloodstream infection (BSI) is a common problem for patients in the intensive care unit (ICU). Nearly 60% of primary bloodstream infections are caused by gram-positive cocci. Gram-positive bacteria gain access to the bloodstream through invasive procedures and various patient care equipment like catheters, intravenous lines, and mechanical ventilators. S. aureus is considered to be the major cause of septicemia. Knowledge of healthcareassociated infections and the antimicrobial susceptibility patterns of the isolates are crucial in guiding empirical treatment.

Methods
This prospective observational study was conducted in Medical ICU, Dayanand Medical College & Hospital, Ludhiana over a period of one year (Dec 2015 to Nov 2016). Patients whose blood cultures tested positive for Gram-positive bacteria were included in the study. This study was carried out to assess the implications and risk factors for nosocomial BSI and several factors, including the age of the patient, the severity of illness, the presence of catheters, and the microorganisms causing the BSI to independently predict mortality. Chief complaints and risk factors were evaluated. APACHE ll score was calculated for all patients and outcomes were analyzed.

Results
In our study, the mean age of patients was 50.93±14.09 years. Central line insertion was found as the most common risk factor (58.7%). A statistically significant correlation was obtained between APACHE SCORE-II and the presence of risk factors i.e. central line insertion (p value-0.010) and diabetes mellitus (p value- 0.003). The most common grampositive pathogen isolated by blood culture was methicillin-sensitive S. aureus (44.2%). For
management, the majority of the patients were prescribed teicoplanin (58.7%). The 28- day overall mortality rate in the present study was 52.9%.

Conclusion
We conclude that independent risk factors like diabetes mellitus, central line insertion, and acute pancreatitis in adult patients with Gram-positive bacteremia were associated with higher mortality. We have also concluded that the administration of early appropriate antibiotics improves patient outcomes.