Evolving pathogens in the surgical intensive care unit: A 6-year experience

Margaret J. Starnes, Carlos V R Brown, Irma R. Morales, Pantelis Hadjizacharia, Ali Salim, Kenji Inaba, Peter Rhee, Demetrios Demetriades

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Nosocomial infections in the intensive care unit (ICU) are well-known causes of morbidity and mortality in critically ill patients. Further complicating this issue is the ever-increasing number of multidrug-resistant pathogens. This study was designed to investigate and document changing microbial trends within the Los Angeles County/University of Southern California Medical Center surgical ICU (SICU), including drug-resistant pathogens. Methods: A 6-year retrospective cohort study of all patients 18 to 85 years old with positive blood, urine, or sputum cultures admitted to an urban, level 1 trauma/SICU. Patients were identified through the Los Angeles County/University of Southern California Medical Center epidemiological records and computerized ICU database. The entire data set was analyzed according to pathogen classification schemes, culture date, type of infection, and with some patient characteristics including sex, average age, and Acute Physiology and Chronic Health Evaluation II score. Two groups were created to analyze changing trends: a past group (2000-2002 cultures) and a present group (2003-2005 cultures). Any repeated cultures were excluded, as was coagulase-negative Staphylococcus, which was considered a contaminant. Results: Over the past 6 years, there were 1164 SICU patients who developed 2260 positive cultures (346 blood, 1,685 respiratory, 229 urine). The average age of patients was 43 ± 19 years, and their average Acute Physiology and Chronic Health Evaluation II score was 22 ± 12. Of the 1164 patients, 76% were male, and 64% suffered trauma injuries. Although there was no difference in the rate of positive blood cultures caused by Gram-positive (GP) or Gram-negative (GN) organisms in the past and present groups (P = .32), GPs became more common in the present group for both respiratory (P < .0001) and urine (P = .004) cultures. In both blood and respiratory cultures, oxacillin-resistant Staphylococcus aureus was a more common GP pathogen (22% vs 7%, P = .004 and 20% vs 11%, P = .004) and represented a larger proportion of staphylococcal species in the present group (50% vs 21%, P = .01 and 30% vs. 21%, P = .04). Conclusions: Our study found that within the SICU, GP organisms play an increasing pathogenic role in critical patients. Staphylococcal species have become more common pathogens in the last 6 years, with an increase in the proportion of drug-resistant strains (oxacillin-resistant S aureus). These findings illustrate the need to keep constant surveillance on microbial trends within the SICU, especially those among drug-resistant pathogens.

Original languageEnglish (US)
Pages (from-to)507-512
Number of pages6
JournalJournal of Critical Care
Volume23
Issue number4
DOIs
StatePublished - Dec 2008

Fingerprint

Critical Care
Intensive Care Units
Oxacillin
APACHE
Los Angeles
Urine
Wounds and Injuries
Pharmaceutical Preparations
Coagulase
Population Growth
Cross Infection
Sputum
Staphylococcus
Critical Illness
Sex Characteristics
Staphylococcus aureus
Cohort Studies
Retrospective Studies
Databases
Morbidity

Keywords

  • Bacteria
  • Cultures
  • Infection
  • Sepsis
  • Surgical intensive care

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Starnes, M. J., Brown, C. V. R., Morales, I. R., Hadjizacharia, P., Salim, A., Inaba, K., ... Demetriades, D. (2008). Evolving pathogens in the surgical intensive care unit: A 6-year experience. Journal of Critical Care, 23(4), 507-512. https://doi.org/10.1016/j.jcrc.2008.02.007

Evolving pathogens in the surgical intensive care unit : A 6-year experience. / Starnes, Margaret J.; Brown, Carlos V R; Morales, Irma R.; Hadjizacharia, Pantelis; Salim, Ali; Inaba, Kenji; Rhee, Peter; Demetriades, Demetrios.

In: Journal of Critical Care, Vol. 23, No. 4, 12.2008, p. 507-512.

Research output: Contribution to journalArticle

Starnes, MJ, Brown, CVR, Morales, IR, Hadjizacharia, P, Salim, A, Inaba, K, Rhee, P & Demetriades, D 2008, 'Evolving pathogens in the surgical intensive care unit: A 6-year experience', Journal of Critical Care, vol. 23, no. 4, pp. 507-512. https://doi.org/10.1016/j.jcrc.2008.02.007
Starnes MJ, Brown CVR, Morales IR, Hadjizacharia P, Salim A, Inaba K et al. Evolving pathogens in the surgical intensive care unit: A 6-year experience. Journal of Critical Care. 2008 Dec;23(4):507-512. https://doi.org/10.1016/j.jcrc.2008.02.007
Starnes, Margaret J. ; Brown, Carlos V R ; Morales, Irma R. ; Hadjizacharia, Pantelis ; Salim, Ali ; Inaba, Kenji ; Rhee, Peter ; Demetriades, Demetrios. / Evolving pathogens in the surgical intensive care unit : A 6-year experience. In: Journal of Critical Care. 2008 ; Vol. 23, No. 4. pp. 507-512.
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abstract = "Background: Nosocomial infections in the intensive care unit (ICU) are well-known causes of morbidity and mortality in critically ill patients. Further complicating this issue is the ever-increasing number of multidrug-resistant pathogens. This study was designed to investigate and document changing microbial trends within the Los Angeles County/University of Southern California Medical Center surgical ICU (SICU), including drug-resistant pathogens. Methods: A 6-year retrospective cohort study of all patients 18 to 85 years old with positive blood, urine, or sputum cultures admitted to an urban, level 1 trauma/SICU. Patients were identified through the Los Angeles County/University of Southern California Medical Center epidemiological records and computerized ICU database. The entire data set was analyzed according to pathogen classification schemes, culture date, type of infection, and with some patient characteristics including sex, average age, and Acute Physiology and Chronic Health Evaluation II score. Two groups were created to analyze changing trends: a past group (2000-2002 cultures) and a present group (2003-2005 cultures). Any repeated cultures were excluded, as was coagulase-negative Staphylococcus, which was considered a contaminant. Results: Over the past 6 years, there were 1164 SICU patients who developed 2260 positive cultures (346 blood, 1,685 respiratory, 229 urine). The average age of patients was 43 ± 19 years, and their average Acute Physiology and Chronic Health Evaluation II score was 22 ± 12. Of the 1164 patients, 76{\%} were male, and 64{\%} suffered trauma injuries. Although there was no difference in the rate of positive blood cultures caused by Gram-positive (GP) or Gram-negative (GN) organisms in the past and present groups (P = .32), GPs became more common in the present group for both respiratory (P < .0001) and urine (P = .004) cultures. In both blood and respiratory cultures, oxacillin-resistant Staphylococcus aureus was a more common GP pathogen (22{\%} vs 7{\%}, P = .004 and 20{\%} vs 11{\%}, P = .004) and represented a larger proportion of staphylococcal species in the present group (50{\%} vs 21{\%}, P = .01 and 30{\%} vs. 21{\%}, P = .04). Conclusions: Our study found that within the SICU, GP organisms play an increasing pathogenic role in critical patients. Staphylococcal species have become more common pathogens in the last 6 years, with an increase in the proportion of drug-resistant strains (oxacillin-resistant S aureus). These findings illustrate the need to keep constant surveillance on microbial trends within the SICU, especially those among drug-resistant pathogens.",
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