Influence of antibiotic-regimens on intensive-care unit-mortality and liver-cirrhosis as risk factor.
OBJECTIVE
To assess the rate of infection, appropriateness of antimicrobial-therapy and mortality on intensive care unit (ICU). Special focus was drawn on patients with liver cirrhosis.


METHODS
The study was approved by the local ethical committee. All patients admitted to the Internal Medicine-ICU between April 1, 2007 and December 31, 2009 were included. Data were extracted retrospectively from all patients using patient charts and electronic documentations on infection, microbiological laboratory reports, diagnosis and therapy. Due to the large hepatology department and liver transplantation center, special interest was on the subgroup of patients with liver cirrhosis. The primary statistical-endpoint was the evaluation of the influence of appropriate versus inappropriate antimicrobial-therapy on in-hospital-mortality.


RESULTS
Charts of 1979 patients were available. The overall infection-rate was 53%. Multiresistant-bacteria were present in 23% of patients with infection and were associated with increased mortality (P < 0.000001). Patients with infection had significantly increased in-hospital-mortality (34% vs 17%, P < 0.000001). Only 9% of patients with infection received inappropriate initial antimicrobial-therapy, no influence on mortality was observed. Independent risk-factors for in-hospital-mortality were the presence of septic-shock, prior chemotherapy for malignoma and infection with Pseudomonas spp. Infection and mortality-rate among 175 patients with liver-cirrhosis was significantly higher than in patients without liver-cirrhosis. Infection increased mortality 2.24-fold in patients with cirrhosis. Patients with liver cirrhosis were at an increased risk to receive inappropriate initial antimicrobial therapy.


CONCLUSIONS
The results of the present study report the successful implementation of early-goal-directed therapy. Liver cirrhosis patients are at increased risk of infection, mortality and to receive inappropriate therapy. Increasing burden are multiresistant-bacteria.
Mireen Friedrich-Rust, Beate Wanger, Florian Heupel, Stefan Zeuzem, Joerg Bojunga, Department of Internal Medicine I (Gastroenterology, Pulmonology, Endocrinology), J.W. Goethe-University Hospital, 60590 Frankfurt, Germany.
Mireen
M
Friedrich-Rust
Mireen Friedrich-Rust, Beate Wanger, Florian Heupel, Stefan Zeuzem, Joerg Bojunga, Department of Internal Medicine I (Gastroenterology, Pulmonology, Endocrinology), J.W. Goethe-University Hospital, 60590 Frankfurt, Germany.
Beate
B
Wanger
Mireen Friedrich-Rust, Beate Wanger, Florian Heupel, Stefan Zeuzem, Joerg Bojunga, Department of Internal Medicine I (Gastroenterology, Pulmonology, Endocrinology), J.W. Goethe-University Hospital, 60590 Frankfurt, Germany.
Florian
F
Heupel
Mireen Friedrich-Rust, Beate Wanger, Florian Heupel, Stefan Zeuzem, Joerg Bojunga, Department of Internal Medicine I (Gastroenterology, Pulmonology, Endocrinology), J.W. Goethe-University Hospital, 60590 Frankfurt, Germany.
Natalie
N
Filmann
Mireen Friedrich-Rust, Beate Wanger, Florian Heupel, Stefan Zeuzem, Joerg Bojunga, Department of Internal Medicine I (Gastroenterology, Pulmonology, Endocrinology), J.W. Goethe-University Hospital, 60590 Frankfurt, Germany.
Reinhard
R
Brodt
Mireen Friedrich-Rust, Beate Wanger, Florian Heupel, Stefan Zeuzem, Joerg Bojunga, Department of Internal Medicine I (Gastroenterology, Pulmonology, Endocrinology), J.W. Goethe-University Hospital, 60590 Frankfurt, Germany.
Volkhard Aj
VA
Kempf
Mireen Friedrich-Rust, Beate Wanger, Florian Heupel, Stefan Zeuzem, Joerg Bojunga, Department of Internal Medicine I (Gastroenterology, Pulmonology, Endocrinology), J.W. Goethe-University Hospital, 60590 Frankfurt, Germany.
Johanna
J
Kessel
Mireen Friedrich-Rust, Beate Wanger, Florian Heupel, Stefan Zeuzem, Joerg Bojunga, Department of Internal Medicine I (Gastroenterology, Pulmonology, Endocrinology), J.W. Goethe-University Hospital, 60590 Frankfurt, Germany.
Thomas A
TA
Wichelhaus
Mireen Friedrich-Rust, Beate Wanger, Florian Heupel, Stefan Zeuzem, Joerg Bojunga, Department of Internal Medicine I (Gastroenterology, Pulmonology, Endocrinology), J.W. Goethe-University Hospital, 60590 Frankfurt, Germany.
Eva
E
Herrmann
Mireen Friedrich-Rust, Beate Wanger, Florian Heupel, Stefan Zeuzem, Joerg Bojunga, Department of Internal Medicine I (Gastroenterology, Pulmonology, Endocrinology), J.W. Goethe-University Hospital, 60590 Frankfurt, Germany.
Stefan
S
Zeuzem
Mireen Friedrich-Rust, Beate Wanger, Florian Heupel, Stefan Zeuzem, Joerg Bojunga, Department of Internal Medicine I (Gastroenterology, Pulmonology, Endocrinology), J.W. Goethe-University Hospital, 60590 Frankfurt, Germany.
Joerg
J
Bojunga
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005858:Germany; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D057970:Inappropriate Prescribing; D007362:Intensive Care Units; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D017064:Process Assessment, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents
Early goal-directed therapy; Intensive care unit; Liver cirrhosis; Mortality; Sepsis-bundle