granada 2004: infections on a ward on internal medicine

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