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©The Author(s) 2016.
World J Gastroenterol. Apr 28, 2016; 22(16): 4201-4210
Published online Apr 28, 2016. doi: 10.3748/wjg.v22.i16.4201
Published online Apr 28, 2016. doi: 10.3748/wjg.v22.i16.4201
Table 1 Characteristics of patients n (%)
| Characteristic | All patients (n = 1979) | Patients without infection (n = 937) | Patients with infection (n = 1042) | OR (95%CI) | P value |
| Age (yr), mean ± SD (range) | 61 ± 16 (16-96) | 61 ± 16 (16-96) | 61 ± 16 (16-95) | 1.003 (0.997-1.008) | > 0.20 |
| Male sex | 1236 (62.5) | 614 (65.5) | 622 (60) | 0.779 (0.649-0.935) | 0.0074 |
| Days on ICU, mean ± SD (range) | 5.53 ± 9.88 (1-217) | 2.89 ± 5.97 (1-76) | 8.12 ± 12 (1-217) | 0.877 (0.858-0.897) | < 0.000001 |
| Hospital-mortality | 489 (24.7) | 140 (14.9) | 349 (33.5) | 2.883 (2.312-3.595) | < 0.000001 |
| Severity score on admission day | |||||
| SAPS II, mean ± SD (range) | 35 ± 16 (5-93) | 30 ± 14 (5-80) | 39 ± 16 (5-93) | 0.958 (0.950-0.965) | < 0.000001 |
| TISS, mean ± SD (range) | 9.5 ± 8.8 (0-55) | 6.3 ± 7.4 (0-35) | 11.6 ± 9.1 (0-55) | 0.925 (0.912-0.938) | < 0.000001 |
| Highest severity score within 7 d after admission | |||||
| SAPS II, mean ± SD (range) | 39 ± 17 (6-93) | 32 ± 15 (6-91) | 44 ± 17 (6-93) | 0.954 (0.947-0.961) | < 0.000001 |
| TISS, mean ± SD (range) | 12.0 ± 9.4 (0-55) | 7.5 ± 8.0 (0-35) | 14.6 ± 9.1 (0-55) | 0.909 (0.897-0.921) | < 0.000001 |
| Type of admission | < 0.000001 | ||||
| Internal medicine ICU | 825 (41.7) | 275 (29.3) | 550 (52.8) | ||
| Cardiology ICU | 1154 (58.3) | 663 (70.8) | 491 (47.1) | ||
| Source of admission | < 0.000001 | ||||
| Emergency department | 923 (46.6) | 468 (49.9) | 455 (43.7) | Reference | |
| Other hospital | 274 (13.8) | 87 (9.3) | 187 (17.9) | 2.211 (1.662-2.941) | < 0.000001 |
| Hospital ward | 613 (31.0) | 276 (29.5) | 337 (32.2) | 1.256 (1.023-1.541) | 0.029 |
| Operating room | 132 (67.0) | 98 (10.5) | 34 (3.3) | 0.357 (0.237-0.538) | 0.000001 |
| Surgical IMC/ICU | 38 (1.9) | 9 (0.96) | 29 (2.8) | 3.314 (1.552-7.079) | 0.0020 |
| Comorbid conditions | 1410 (71.2) | 607 (64.8) | 803 (77.1) | 1.840 (1.511-2.241) | < 0.000001 |
| COPD | 233 (11.8) | 84 (9.0) | 149 (14.3) | 1.696 (1.278-2.252) | 0.00026 |
| Heart failure (EF < 30%) | 114 (5.8) | 59 (6.3) | 55 (5.3) | 0.830 (0.569-1.212) | > 0.20 |
| Coronary artery disease | 455 (23.0) | 244 (26.0) | 211 (20.2) | 0.722 (0.585-0.891) | 0.0024 |
| Chronic renal failure | 342 (34.2) | 140 (14.9) | 202 (19.4) | 1.371 (1.082-1.736) | 0.0089 |
| Diabetes mellitus | 474 (24.0) | 227 (24.2) | 247 (23.7) | 0.973 (0.791-1.197) | > 0.20 |
| Liver-cirrhosis | 175 (8.8) | 57 (6.1) | 118 (11.3) | 1.974 (1.420-2.744) | 0.000052 |
| Cancer | 229 (11.6) | 89 (9.5) | 140 (13.4) | 1.481 (1.117-1.962) | 0.0063 |
| Hematologic neoplasia | 111 (5.6) | 39 (4.2) | 72 (6.9) | 1.711 (1.147-2.553) | 0.0085 |
| HIV | 76 (3.8) | 15 (1.6) | 61 (5.9) | 3.826 (2.160-6.779) | 0.0000043 |
| Immunosuppressive Tx | 106 (5.4) | 29 (3.1) | 77 (7.4) | 2.501 (1.616-3.870) | 0.000039 |
| Chemotherapy | 108 (5.5) | 32 (3.4) | 76 (7.3) | 2.230 (1.461-3.403) | 0.00020 |
| Number of cormobid conditions | 0.000023 | ||||
| 0 | 566 (28.6) | 330 (35.2) | 236 (22.6) | ||
| 1 | 593 (30.0) | 257 (27.4) | 336 (32.2) | ||
| 2 | 415 (21.0) | 174 (18.6) | 241 (23.1) | ||
| 3 | 260 (13.1) | 109 (11.6) | 151 (14.5) | ||
| > 3 | 146 (7.4) | 68 (7.3) | 78 (7.5) | ||
| Mechanical ventilation | 942 (47.6) | 265 (28.3) | 677 (65.0) | 4.710 (3.892-5.701) | <0.000001 |
| Hemodialysis | 274 (13.8) | 61 (6.5) | 213 (20.4) | 3.694 (2.736-4.987) | <0.000001 |
Table 2 Site of infection and types of microorganisms in culture-positive infected patients n (%)
| All patients with infection (n = 1042) | Appropriate therapy (n = 948) | Inappropriate therapy (n = 94) | P value | |
| Site of primary infection | ||||
| Respiratory tract | 716 (68.7) | 658 (69.4) | 58 (61.7) | 0.12 |
| Abdomen/GIT | 49 (4.7) | 46 (4.9) | 3 (3.2) | > 0.20 |
| Renal/urinary tract | 33 (3.2) | 32 (3.4) | 1 (1.1) | > 0.20 |
| Skin | 13 (1.2) | 13 (1.4) | 0 | > 0.20 |
| CNS | 12 (1.2) | 10 (1.1) | 2 (2.1) | > 0.20 |
| Endocarditis | 26 (2.5) | 24 (2.5) | 2 (2.3) | > 0.20 |
| Bloodstream | 5 (0.5) | 5 (0.5) | 0 | > 0.20 |
| Others | 35 (3.4) | 33 (3.5) | 2 (2.1) | > 0.20 |
| Sepsis | 207 (19.8) | 179 (18.9) | 28 (29.8) | 0.011 |
| Sites with detection of microorganism | ||||
| Respiratory tract | 400 (38.4) | 345 (36.4) | 55 (58.5) | 0.000026 |
| Gastrointestinal | 215 (20.6) | 184 (19.4) | 31 (33.0) | 0.0019 |
| Bloodstream | 156 (15.0) | 130 (13.7) | 26 (27.7) | 0.00030 |
| Renal/urinary tract | 185 (17.8) | 155 (16.4) | 30 (31.9) | 0.000165 |
| Skin | 174 (16.7) | 145 (15.3) | 29 (30.9) | 0.00012 |
| Catheter-related | 51 (4.9) | 39 (4.1) | 12 (12.8) | 0.00021 |
| CNS | 10 (1.0) | 10 (1.1) | 0 | > 0.20 |
| Others | 87 (8.4) | 70 (7.4) | 17 (18.1) | 0.00055 |
| Culture-positive | 697 (66.9) | 606 (63.9) | 91 (69.8) | < 0.000001 |
| Gram-positive isolates | 473 (45.4) | 400 (42.2) | 73 (77.7) | < 0.000001 |
| S. aureus | 187 (17.9) | 171 (18.0) | 16 (17.0) | > 0.20 |
| MRSA | 45 (4.3) | 31 (3.3) | 14 (14.9) | < 0.000001 |
| S. epidermidis | 17 (1.6) | 15 (1.6) | 2 (2.1) | > 0.20 |
| S. pneumoniae | 16 (1.5) | 12 (1.3) | 4 (4.3) | 0.025 |
| VSE | 93 (8.9) | 67 (7.1) | 26 (27.7) | < 0.000001 |
| VRE | 91 (8.7) | 68 (7.2) | 23 (24.5) | < 0.000001 |
| Others | 172 (16.5) | 138 (14.5) | 34 (36.2) | < 0.000001 |
| Gram-negative isolates | 368 (35.3) | 320 (33.8) | 48 (51.1) | 0.00081 |
| E. coli | 99 (9.5) | 89 (9.4) | 10 (10.6) | > 0.20 |
| Enterobacter spp. | 45 (4.3) | 39 (4.1) | 6 (6.4) | > 0.20 |
| Klebsiella spp. | 56 (5.4) | 49 (5.2) | 7 (7.4) | > 0.20 |
| Pseudomonas spp. | 93 (8.9) | 79 (8.3) | 14 (14.9) | 0.033 |
| Acinetobacter spp. | 10 (1.0) | 5 (0.5) | 5 (5.3) | 0.0000055 |
| ESBL-producing Enterobacteriaceae | 42 (4.0) | 37 (3.9) | 5 (5.3) | > 0.20 |
| Others | 148 (14.2) | 122 (12.8) | 26 (27.7) | 0.00099 |
| Other bacteria | 17 (1.6) | 11 (1.2) | 6 (6.4) | 0.00014 |
| Fungi | 484 (46,5) | 421 (40,4) | 63 (6,1) | 0.00028 |
| Candia albicans | 406 (39.0) | 359 (37.9) | 47 (50) | 0.021 |
| Other Candida spp. | 197 (18.9) | 165 (17.4) | 32 (3.4) | 0.010 |
| C. glabrata | 128 (12.3) | 108 (11.4) | 20 (21.3) | |
| C. tropicalis | 39 (3.7) | 33 (3.5) | 6 (6.4) | |
| C. krusei | 17 (1.6) | 13 (1.4) | 4 (4.3) | |
| Others | 13 (1.3) | 11 (1.2) | 2 (2.1) | |
| Aspergillus spp. | 27 (2.6) | 8 (0.8) | 19 (20.2) | < 0.000001 |
| Pneumocystis jiroveci | 14 (1.3) | 4 (0.4) | 10 (10.6) | < 0.000001 |
| Other fungi | 10 (1.0) | 10 (1.1) | 0 | > 0.20 |
| Parasites | 1 (0.1) | 1 (0.1) | 0 | 0.00072 |
| Multiresistant-bacteria | 235 (22.6) | 180 (19.0) | 55 (58.5) | < 0.000001 |
| MRSA | 45 (4.3) | 31 (3.3) | 14 (14.9) | |
| VRE | 91 (8.7) | 68 (7.2) | 23 (24.5) | |
| ESBL-producing | 42 (4.0) | 37 (3.9) | 5 (5.3) | |
| Enterobacteriaceae | ||||
| Pseudomonas spp. | 16 (1.5) | 14 (1.5) | 2 (2.2) | |
| Stenotrophomonas spp. | 19 (1.8) | 12 (1.3) | 7 (7.4) | |
| Acinetobacter spp. | 3 (0.29) | 1 (0.1) | 2 (2.2) | |
| Others | 21 (2.01) | 19 (2.0) | 2 (2.2) | |
Table 3 Characteristics of patients with infection according to appropriate or inappropriate antimicrobial-therapy n (%)
| Characteristic | All patients with infection (n = 1042) | Appropriate therapy (n = 948) | Inappropriate therapy (n = 94) | OR (95%CI) | P value |
| Age (yr), mean ± SD (range) | 61 ± 16 (16-95) | 61 ± 16 (16-95) | 61 ± 14 (21-88) | 1.003 (0.99-1.017) | > 0.20 |
| Male sex | 622 (60.0) | 376 (39.7) | 0.747 (0.488-1.143) | 0.18 | |
| Days on ICU, mean ± SD (range) | 8.12 ± 12 (1-217) | 7.68 ± 11.958 (1-217) | 10.02 ± 11.134 (1-59) | 1.011 (0.998-0.024) | 0.092 |
| ICU-mortality | 324 (31.3) | 287 (30.3) | 37 (39.4) | 0.669 (0.432-1.035) | 0.071 |
| Hospital-mortality | 350 (33.6) | 310 (32.7) | 40 (42.6) | 0.656 (0.426-1.009) | 0.055 |
| Severity score on admission day | |||||
| SAPS II, mean ± SD (range) | 38.67 ± 15.64 (5-93) | 38.54 ± 15.82 (5-93) | 39.95 ± 13.78 (8-68) | 1.006 (0.992-1.020) | > 0.20 |
| TISS, mean ± SD (range) | 11.57 ± 9.11 (0-55) | 11.74 ± 9.25 (0-55) | 9.86 ± 7.42 (0-28) | 0.976 (0.951-1.002) | 0.071 |
| Highest severity score within 7 d after admission | |||||
| SAPS II, mean ± SD (range) | 43.88 ± 16.57 (6-93) | 43.68 ± 16.71 (6-93) | 45.87 ± 15.09 (8-81) | 1.008 (0.994-1.022) | > 0.20 |
| TISS. mean ± SD (range) | 14.65 ± 9.14 (0-55) | 14.68 ± 9.27 (0-55) | 14.32 ± 7.73 (0-38) | 0.996 (0.971-1.021) | > 0.20 |
| Type of Admission | 0.0022 | ||||
| Internal Medicine ICU | 550 (52.8) | 486 (51.3) | 64 (68.1) | ||
| Cardiology ICU | 491 (47.1) | 461 (48.7) | 30 (31.9) | ||
| Source of admission | > 0.20 | ||||
| Emergency department | 455 (43.7) | 418 (44.1) | 37 (39.4) | Reference | |
| Other hospital | 187 (17.9) | 170 (17.9) | 17 (18.1) | 0.425 (0.153-1.179) | 0.10 |
| Hospital ward | 337 (32.3) | 305 (32.2) | 32 (34.0) | 0.48 (0.162-1.429) | 0.19 |
| Operating room | 34 (3.3) | 31 (3.3) | 3 (3.2) | 0.504 (0.18-1.411) | 0.19 |
| Surgical IMC/ICU | 29 (2.7) | 24 (2.6) | 5 (5.3) | 0.465 (0.101-2.14) | > 0.20 |
| Comorbid conditions | 806 (77.4) | 729 (76.9) | 77 (81.9) | 0.842 (0.498-1.424) | > 0.20 |
| COPD | 149 (14.3) | 137 (14.5) | 12 (12.8) | 1.154 (0.613-2.172) | > 0.20 |
| Heart failure (EF < 30%) | 55 (5.3) | 50 (5.3) | 5 (5.3) | 0.991 (0.385-2.549) | > 0.20 |
| Coronary artery disease | 211 (20.2) | 195 (20.6) | 16 (17.0) | 1.262 (0.721-2.211) | > 0.20 |
| Chronic renal failure | 202 (19.4) | 182 (19.2) | 20 (21.3) | 0.879 (0.523-1.478) | > 0.20 |
| Diabetes mellitus | 247 (23.7) | 220 (23.2) | 27 (28.7) | 0.750 (0.468-1.202) | > 0.20 |
| Liver-cirrhosis | 118 (11.3) | 100 (10.5) | 18 (19.1) | 0.498 (0.286-0.866) | 0.014 |
| Cancer | 140 (13.4) | 122 (12.9) | 18 (19.1) | 0.624 (0.361-1.079) | 0.091 |
| Hematologic neoplasia | 72 (6.9) | 68 (7.2) | 4 (4.3) | 1.739 (0.620-4.877) | > 0.20 |
| HIV | 61 (5.9) | 51 (5.4) | 10 (10.6) | 0.478 (0.234-0.975) | 0.042 |
| Immunosuppressive Tx. | 77 (7.4) | 69 (7.3) | 8 (8.5) | 0.844 (0.393-1.813) | > 0.20 |
| Chemotherapy | 53 (5.1) | 47 (5.0) | 6 (6.4) | 2.634 (1.691-4.102) | 0.000018 |
| Number of cormobid conditions | > 0.20 | ||||
| 0 | 236 | 219 (23.1) | 17 (18.1) | ||
| 1 | 336 | 304 (32.1) | 32 (34.0) | ||
| 2 | 241 | 219 (23.1) | 22 (23.4) | ||
| 3 | 151 | 138 (14.6) | 13 (13.8) | ||
| > 3 | 78 | 68 (7.2) | 10 (10.6) | ||
| Mechanical ventilation | 677 (65.0) | 621 (65.5) | 56 (59.6) | 1.289 (0.836-1.987) | > 0.20 |
| Hemodialysis | 213 (20.4) | 194 (20.5) | 19 (20.2) | 1.016 (0.599-1.721) | > 0.20 |
Table 4 Risk factors for in hospital mortality n (%)
| Characteristic | Patients who died in hospital | Patients surviving | Odds ratio | P value |
| Age (yr) | 63 | 60 | 0.0011 | |
| SAPS II score (mean) | 47 | 37 | < 0.000001 | |
| TISS score (mean) | 12.8 | 8.5 | < 0.000001 | |
| Number of comorbid conditions | 1.851 [1.446-2.369] | < 0.000001 | ||
| Chemotherapy for malignoma within 3 mo prior to admission | 2.385 [1.605-3.543] | 0.000017 | ||
| Clinical infection on admission | 2.883 [2.312-3.595] | < 0.000001 | ||
| Septic-shock on admission | 4.993 [3.707-6.727] | < 0.000001 | ||
| Bacteriemia | 2.119 [1.515-2.962] | < 0.000001 | ||
| Multiresistant-bacterial infections | 2.189 [1.664-2.879] | < 0.000001 | ||
| mechanical ventilation during ICU stay | 5.018 [3.981-6.324] | < 0.000001 | ||
| C-reactive-protein at admission (mg/dL) | 8.76 | 6.23 | < 0.000001 | |
| Creatinine-values at admission (mg/dL) | 1.93 | 1.644 | < 0.000001 | |
| Bilirubin-values at admission (mg/dL) | 3.175 | 1.818 | 0.0014 | |
| INR | 1.81 | 1.46 | < 0.000001 |
Table 5 Risk factors for in hospital mortality of patients with infection
| Characteristic | Patients who died in hospital | Patients surviving | Odds ratio | P value |
| SAPS II score (mean) | 42 | 37 | 0.00021 | |
| TISS score (mean) | 12.7 | 11.03 | 0.0084 | |
| Number of comorbid conditions | 1.824 [1.311-2.539] | 0.00036 | ||
| mechanical ventilation during ICU stay | 2.363 [1.765-3.164] | < 0.000001 | ||
| pulmonary-infections | 1.741 [1.301-2.33] | 0.00020 | ||
| catheter-related infection | 2.578 [1.51-4.399] | 0.00052 | ||
| bilirubin-values at admission (mg/dL) | 3.39 | 2.458 | 0.0300 | |
| INR | 1.83 | 1.55 | 0.0000082 |
- Citation: Friedrich-Rust M, Wanger B, Heupel F, Filmann N, Brodt R, Kempf VA, Kessel J, Wichelhaus TA, Herrmann E, Zeuzem S, Bojunga J. Influence of antibiotic-regimens on intensive-care unit-mortality and liver-cirrhosis as risk factor. World J Gastroenterol 2016; 22(16): 4201-4210
- URL: https://www.wjgnet.com/1007-9327/full/v22/i16/4201.htm
- DOI: https://dx.doi.org/10.3748/wjg.v22.i16.4201