Analiza učestalosti i ishoda akutnih infekcija u internističkoj jedinici intenzivne medicine

master's thesis

• Title (english): Incidence and outcome of acute infections in the medical intensive care unit
• Author: Filip Babić
• Mentor: Vesna Degoricija (mentor)
• Committee member: Radovan Radonić (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Vesna Degoricija (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Intensive Care

Abstract

Akutne infekcije čine jedan od vodećih razloga prijema u jedinicu intenzivnog liječenja i njihova učestalost je u porastu. S obzirom na teško stanje, visoku dob te često invazivne postupke kojima su izloženi bolesnici u jedinicama intenzivnog liječenja mortalitet infekcija je visok. Među najčešćim infekcijama su sepsa, pneumonija te infekcije mokraćnog sustava. Provedeno je retrospektivno istraživanje među bolesnicima liječenima u Zavodu za intenzivnu medicinu Klinike za unutarnje bolesti Kliničkog bolničkog centra Sestre milosrdnice od 1.1.2018. do 31.12.2018. s ciljem analize učestalosti i ishoda infekcija u Zavodu te prepoznavanja najčešćih uzročnika. Istraživanje je obuhvatilo 761 bolesnika među kojima je najčešći razlog prijema u Zavod bila sepsa s 27.9%. U odnosu na ukupni mortalitet od 23.4%, mortalitet sepse bio je 37.7%, a sepse sa septičkim šokom 64.6%. Kao najčešći uzročnici nađeni su Escherichia coli, Staphylococcus spp. te Klebsiella pneumoniae. Zabilježeno je i 346 slučajeva neseptičnih akutnih infekcija među 549 bolesnika koji nisu liječeni od sepse. Od promatranih infekcija, najčešće su bile infekcija mokraćnog sustava (25.7% svih slučajeva) praćena pneumonijom (19.7%), akutnom egzacerbacijom kronične opstruktivne plućne bolesti (13.1%) te infekcijom mekih tkiva (4.6%). Vodeći uzročnici tih infekcija bili su Escherichia coli, Streptococcus pneumoniae, Haemophilus influenzae te Pseudomonas aeruginosa. Smrtnost među bolesnicima s ovim infekcijama, bila im to osnovna bolest ili komplikacija osnovnog stanja, kretala se između 12 i 27.8%. U odnosu na ranija istraživanja, učestalost sepse u višestrukom je porastu, mortalitet sepse je također porastao dok se mortalitet septičkog šoka nije mijenjao. U profilu uzročnika je niska učestalost bakterija koje su češće multirezistentne od ostalih. Dobiveni rezultati se uvelike poklapaju s rezultatima većih europskih i svjetskih studija.

Abstract (english)

Acute infections are one of the leading causes of admission to intensive care unit and their incidence is increasing. As the patients treated in intensive care unit are often in bad condition, of older age and often exposed to many invasive procedures, the mortality of infections is high. One of the most common infections are sepsis, pneumonia and urinary tract infections. A retrospective study was conducted among the patients treated in Intensive care unit of the Sisters of Charity University Hospital Centre in the period between January 1st 2018 and December 31st 2018. The aim of the study was to analyse the frequency and outcomes of infections in the unit and to investigate the most common pathogens causing the infections. The study included 761 patients whose leading reason for admission was sepsis which accounted for 27.9%. The total mortality was 23.4%, the mortality of sepsis was 37.7% and the mortality of sepsis combined with sepsis shock was 64.6%. The most common pathogens were Escherichia coli, Staphylococcus spp. and Klebsiella pneumoniae. Moreover, 346 cases of non-septic infections were noted among the 549 patients who were not treated for sepsis. Among the infections of interest, the most common were urinary tract infection (25.7% of all cases) followed by pneumonia (19.7%), acute exacerbation of chronic obstructive lung disease (13.1%) and soft tissue infection (4.6%). The most frequent pathogens isolated in those infections were Escherichia coli, Streptococcus pneumoniae, Haemophilus influenzae and Pseudomonas aeruginosa. The mortality of patients with acute non-septic infections as their main illness or as the complication of another condition was between 12 and 27.8%. In comparison with earlier studies, the frequency of sepsis is found to be several times higher, the sepsis mortality is also increasing while the sepsis shock mortality has not changed. The pathogen profile shows a low incidence of bacteria with high multi-resistency potential. Our results are consistent with the results of larger European and world studies.

• Keywords: jedinica intenzivnog liječenja; akutne infekcije; sepsa; incidencija; smrtnost
• Keywords (english): intensive care unit; acute infections; sepsis; incidence; outcome
• Language: croatian
• URN:NBN: urn:nbn:hr:105:976728
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-08-30 08:07:08