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Influence of antibiotic-regimens on intensive-care unit-mortality and liver-cirrhosis as risk factor

World Journal of Gastroenterology 2016年第16期22卷 4201-4210页

作者： 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 Department of Internal Medicine I (Gastroenterology Pulmonology Endocrinology) J.W. Goethe-University Hospital Institute of Biostatistics and Mathematical Modeling Faculty of Medicine J.W. Goethe-University Department of Internal Medicine II (Infectious Disease Oncology Hematology) J.W. Goethe-University Hospital Institute of Medical Microbiology and Infection Control J.W. Goethe-University Hospital

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 ***: 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 versusinappropriate antimicrobial-therapy on ***: Charts of 1979 patients were available. The overall infection-rate was 53%. Multiresistantbacteria 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 septicshock, 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 ***: 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-b

关键词： Intensive care unit Sepsis-bundle Early goal-directed therapy Liver cirrhosis Mortality

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