Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2016; 22(16): 4201-4210
Published online Apr 28, 2016. doi: 10.3748/wjg.v22.i16.4201
Influence of antibiotic-regimens on intensive-care unit-mortality and liver-cirrhosis as risk factor
Mireen Friedrich-Rust, Beate Wanger, Florian Heupel, Natalie Filmann, Reinhard Brodt, Volkhard AJ Kempf, Johanna Kessel, Thomas A Wichelhaus, Eva Herrmann, Stefan Zeuzem, Joerg Bojunga
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 Filmann, Eva Herrmann, Institute of Biostatistics and Mathematical Modeling, Faculty of Medicine, J.W. Goethe-University, 60590 Frankfurt, Germany
Reinhard Brodt, Johanna Kessel, Department of Internal Medicine II (Infectious Disease, Oncology, Hematology), J.W. Goethe-University Hospital, 60590 Frankfurt, Germany
Volkhard AJ Kempf, Thomas A Wichelhaus, Institute of Medical Microbiology and Infection Control, J.W. Goethe-University Hospital, 60590 Frankfurt, Germany
Author contributions: Friedrich-Rust M, Herrmann E, Bojunga J participated in the design of the study; all authors participated in the clinical study, data acquisition and extraction; Friedrich-Rust M, Wanger B, Heupel F, Filmann N and Herrmann E performed the statistical analysis; Friedrich-Rust M, Wanger B, Heupel F, Filmann N, Bojunga J participated in the drafting of the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the University Clinic Frankfurt.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained retrospectively.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Mireen Friedrich-Rust, Professor, Department of Internal Medicine I (Gastroenterology, Pulmonology, Endocrinology), J.W. Goethe-University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany. mireen.friedrich-rust@kgu.de
Telephone: +49-69-63015297 Fax: +49-69-63016247
Received: January 13, 2016
Peer-review started: January 16, 2016
First decision: January 28, 2016
Revised: February 9, 2016
Accepted: March 13, 2016
Article in press: March 14, 2016
Published online: April 28, 2016
Abstract

AIM: 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.

CONCLUSION: 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.

Keywords: Intensive care unit, Sepsis-bundle, Early goal-directed therapy, Liver cirrhosis, Mortality

Core tip: This is a retrospective study evaluating the association of appropriate and inappropriate antimicrobial therapy on intensive care unit-mortality with special focus on patients with liver cirrhosis. Charts of 1979 patients were available for analysis. Patients with infection had significantly increased in-hospital mortality. Only 9% of patients with infection received inappropriate initial antimicrobial therapy. Multiresistant bacteria were detected in 23% of patients with infection and were associated with increased mortality. 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.