Prevalence and predictors of confirmed infection in patients receiving empiric antimicrobials in the intensive care unit: a retrospective cohort study
Background: Infection diagnosis in Intensive Care Units (ICUs) is a challenge given the spectrum of conditions that present with systemic inflammation, the illness severity and the delay and imprecision of existing diagnostic methods. We hence sought to analyze the prevalence and predictors of confi...
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Elsevier
2025-01-01
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| Series: | Brazilian Journal of Anesthesiology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0104001424000897 |
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| author | Luis Carlos Maia Cardozo Júnior Larissa Bianchini Jakeline Neves Giovanetti Luiz Marcelo Almeida de Araújo Yuri de Albuquerque Pessoa dos Santos Bruno Adler Maccagnan Pinheiro Besen Marcelo Park |
| author_facet | Luis Carlos Maia Cardozo Júnior Larissa Bianchini Jakeline Neves Giovanetti Luiz Marcelo Almeida de Araújo Yuri de Albuquerque Pessoa dos Santos Bruno Adler Maccagnan Pinheiro Besen Marcelo Park |
| author_sort | Luis Carlos Maia Cardozo Júnior |
| collection | DOAJ |
| description | Background: Infection diagnosis in Intensive Care Units (ICUs) is a challenge given the spectrum of conditions that present with systemic inflammation, the illness severity and the delay and imprecision of existing diagnostic methods. We hence sought to analyze the prevalence and predictors of confirmed infection after empirical antimicrobials during ICU stay. Methods: retrospective cohort of prospectively collected ICU data in an academic tertiary hospital in São Paulo, Brazil. We included all adult patients given a new empirical antimicrobial during their ICU stay. We excluded patients using prophylactic or microbiologically guided antimicrobials. Primary outcome was infection status, defined as confirmed, probable, possible, or discarded. In a multivariable analysis, we explored variables associated with confirmed infection. Results: After screening 1721 patients admitted to the ICU from November 2017 to November 2022, we identified 398 new antimicrobial prescriptions in 341 patients. After exclusions, 243 antimicrobial prescriptions for 206 patients were included. Infection was classified as confirmed in 61 (25.1%) prescriptions, probable in 39 (16.0%), possible in 103 (42.4%), and discarded in 40 (16.5%). The only factor associated with infection was deltaSOFA (OR = 1.18, 95% CI 1.02 to 1.36, p = 0.022). Conclusion: Suspected infection in the ICU is frequently not confirmed. Clinicians should be aware of the need to avoid premature closure and revise diagnosis after microbiological results. Development and implementation of new tools for faster infection diagnosis and guiding of antimicrobial prescription should be a research priority. |
| format | Article |
| id | doaj-art-3ac9100e9629461e88f308f17dc3d6aa |
| institution | Kabale University |
| issn | 0104-0014 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Anesthesiology |
| spelling | doaj-art-3ac9100e9629461e88f308f17dc3d6aa2025-02-01T04:11:32ZengElsevierBrazilian Journal of Anesthesiology0104-00142025-01-01751844567Prevalence and predictors of confirmed infection in patients receiving empiric antimicrobials in the intensive care unit: a retrospective cohort studyLuis Carlos Maia Cardozo Júnior0Larissa Bianchini1Jakeline Neves Giovanetti2Luiz Marcelo Almeida de Araújo3Yuri de Albuquerque Pessoa dos Santos4Bruno Adler Maccagnan Pinheiro Besen5Marcelo Park6Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas, Departamento de Emergência, Unidade de Terapia Intensiva, São Paulo, SP, Brazil; Corresponding author.Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas, Departamento de Emergência, Unidade de Terapia Intensiva, São Paulo, SP, BrazilFaculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas, Departamento de Emergência, Unidade de Terapia Intensiva, São Paulo, SP, BrazilFaculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas, Departamento de Emergência, Unidade de Terapia Intensiva, São Paulo, SP, BrazilFaculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas, Departamento de Emergência, Unidade de Terapia Intensiva, São Paulo, SP, Brazil; Hospital Samaritano Paulista, Unidade de Terapia Intensiva, São Paulo, SP, BrazilFaculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas, Departamento de Emergência, Unidade de Terapia Intensiva, São Paulo, SP, Brazil; Hospital A.C. Camargo Cancer Center, Unidade de Terapia Intensiva, São Paulo, SP, BrazilFaculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas, Departamento de Emergência, Unidade de Terapia Intensiva, São Paulo, SP, BrazilBackground: Infection diagnosis in Intensive Care Units (ICUs) is a challenge given the spectrum of conditions that present with systemic inflammation, the illness severity and the delay and imprecision of existing diagnostic methods. We hence sought to analyze the prevalence and predictors of confirmed infection after empirical antimicrobials during ICU stay. Methods: retrospective cohort of prospectively collected ICU data in an academic tertiary hospital in São Paulo, Brazil. We included all adult patients given a new empirical antimicrobial during their ICU stay. We excluded patients using prophylactic or microbiologically guided antimicrobials. Primary outcome was infection status, defined as confirmed, probable, possible, or discarded. In a multivariable analysis, we explored variables associated with confirmed infection. Results: After screening 1721 patients admitted to the ICU from November 2017 to November 2022, we identified 398 new antimicrobial prescriptions in 341 patients. After exclusions, 243 antimicrobial prescriptions for 206 patients were included. Infection was classified as confirmed in 61 (25.1%) prescriptions, probable in 39 (16.0%), possible in 103 (42.4%), and discarded in 40 (16.5%). The only factor associated with infection was deltaSOFA (OR = 1.18, 95% CI 1.02 to 1.36, p = 0.022). Conclusion: Suspected infection in the ICU is frequently not confirmed. Clinicians should be aware of the need to avoid premature closure and revise diagnosis after microbiological results. Development and implementation of new tools for faster infection diagnosis and guiding of antimicrobial prescription should be a research priority.http://www.sciencedirect.com/science/article/pii/S0104001424000897Anti-bacterial agentsAntimicrobial stewardshipIntensive care unitsHealthcare associated infections |
| spellingShingle | Luis Carlos Maia Cardozo Júnior Larissa Bianchini Jakeline Neves Giovanetti Luiz Marcelo Almeida de Araújo Yuri de Albuquerque Pessoa dos Santos Bruno Adler Maccagnan Pinheiro Besen Marcelo Park Prevalence and predictors of confirmed infection in patients receiving empiric antimicrobials in the intensive care unit: a retrospective cohort study Brazilian Journal of Anesthesiology Anti-bacterial agents Antimicrobial stewardship Intensive care units Healthcare associated infections |
| title | Prevalence and predictors of confirmed infection in patients receiving empiric antimicrobials in the intensive care unit: a retrospective cohort study |
| title_full | Prevalence and predictors of confirmed infection in patients receiving empiric antimicrobials in the intensive care unit: a retrospective cohort study |
| title_fullStr | Prevalence and predictors of confirmed infection in patients receiving empiric antimicrobials in the intensive care unit: a retrospective cohort study |
| title_full_unstemmed | Prevalence and predictors of confirmed infection in patients receiving empiric antimicrobials in the intensive care unit: a retrospective cohort study |
| title_short | Prevalence and predictors of confirmed infection in patients receiving empiric antimicrobials in the intensive care unit: a retrospective cohort study |
| title_sort | prevalence and predictors of confirmed infection in patients receiving empiric antimicrobials in the intensive care unit a retrospective cohort study |
| topic | Anti-bacterial agents Antimicrobial stewardship Intensive care units Healthcare associated infections |
| url | http://www.sciencedirect.com/science/article/pii/S0104001424000897 |
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