granada 2004: infections on a ward on internal medicine
TRANSCRIPT
Javier Rodríguez-Vera, Estela Ferrão, Teresa Taveira, M. José Grade,
I. Duarte, Luisa Arez, Rui Tomé
Department of Internal Medicine. Sector I.
Hospital do Barlavento Algarvio. Portimão. Portugal. EU.
INFECTIOUS DISEASES IN A WARD OF INTERNAL MEDICINE: A PROSPECTIVE
STUDY
Introduction
• Infectious diseases:
– How common?
– What kind?
– What treatment?
Objective
• Describing the characteristics of the
patients with infectious diseases in our
ward.
Material and Method (I)
• Prospective review of patients admitted in Medicine I during September 2003.
•Inclusion criteria:–Patients admitted for infectious diseases .–Patients with intercurrent infectious diseases during the stay.
Material and Method (II)Parameters studied:
Demographic: age, gender
Predisposing factors for infections
Location of the infection
Antibiotic treatment prescribed
Material and Method (III)Limitations of the study
Antibiogram of isolated germens not studied.
Without information about the concurrence of the infections.
Material and Method (IV)
• 9 rooms, 24 beds: – 6 with 3 beds– 3 with 2 beds (occasionally, isolation)
• Medical staff: – 6 Specialists in Internal Medicine– 1 trainee of Internal Medicine
Characteristics of Sector I Medicine
Results (I)
• N=73
• Average stay: 9,5 days
• Deaths: 8 (10,9%)
General statistics of Medicine I - September 2003
Results (II)
• N=25. Infections=41.
• Average stay: 13,08 days
• Deaths: 5 (20%)
• Average age: 73,91 yrs
• Gender M:F (%) 36:64
Population included in the study
0
10
20
30
40
50
60
70
80
9,5
13,08
0
2
4
6
8
10
12
14
Overall Infected
10,9
20
0
2
4
6
8
10
12
14
16
18
20
Overall Infected
Results (III)Comparisons Infected-Average
Average stay (days) Mortality (percentage)
Results (III)
• Comorbidity:– Malnutrition: 28%– Neoplasm: 20%
Predisposing factors for infection
•Pressure ulcers:
–Before the admission: 4 (16%)
–During the stay: 1 (4%)
•Extrinsic risk factors:
–Peripheral venous cannulation: 80%
–Urinary drain:68%
–Nasogastric drain: 28%
Results (IV) Infections by location
44%
28%
16%12% Urine
LungHemocultures +Pressure ulcer
Results (V)
• N=43
• Not done= 5 (11,6%)
Most common results of the cultures
24%
19%
13%
14%
5%
5%
5%
3%3% 3% 3% 3% E. Coli
Negative/ND
Pseudomonas ae
levaduras/Cándida a.
M TB
MRSA
KL. Pneu
E. Faecium
St epidermdis
Ac. Baumanii
St agalactiae
Cont
Results (VI)Most results by location
Pse
udom
onas
E.c
oli
Can
dida
a
cont
amin
ed
E. F
aeci
um
Aci
neto
bact
er b
aum
anii
kleb
siel
la p
neum
onia
e
Neg
ativ
e
Not
don
e
Myc
obac
teri
um T
BC
Sta
ph e
pide
rmid
is
Str
ep. A
gala
ctia
e
MR
SA
Pressure Ulcer
Hemoculture +
Sepsis
Urine
Lung
Results (VII)Antibiotics used
Amox/Clav22%
Ceftriax19%
Fluconazol8%
Pp/Tz10%
Meropenem4%
Gentam6%
Ciprofloxacin19%
Teicoplanin2%
Cefox2%
Imipenem4%
R+I+P+E4%
AM
X/C
lav
Cef
tria
xone
Cip
roflo
xaci
n
Pp/
Tz
Imip
enem
Mer
open
em
Fluc
onaz
ol
Itrac
onaz
ole
Am
phoB
Van
co
Cef
oxiti
n
Cot
rim
oxaz
ol
RIP
E
Met
ro
Gen
ta
Teic
o
U R IN E
LU N G
HEM O C U LT +
PR ES S U R E U LC ER S
S EPS IS
Antibiotics used by locationResults (VIII)
CONCLUSIONS(I)
1. The infectious diseases are responsible for an increase of mortality and average stay in our ward. 2. The pressure ulcers are the main cause of nosocomial infections.3. The empiric antibiotherapy was not effective in 45,83%, probably related to an increase of the resistance to antibiotics and the need for more aggressive therapeutic approaches