The evaluation of treatment responses to the blood stream infections in intensive care unit patients and reasons of treatment failures

We aimed to investigate the treatment responses of ICU-acquired BSI cases and the reasons of treatment failures.The prospective, observational, cohort study was conducted between October 2010 and October 2011 in 4 ICUs (Anesthesia and Reanimation, Medical, Neurology, Brain Surgery ICUs) of Gazi University Faculty of Medicine. Fifty of total 70 patients had treatment failure (71,4%), while 20 of whom had treatment success (28,6 %).APACHE II scores, used to measure severity of illness 48 h before bacteremia onset were higher in patients with treatment failure. The analyses of the outcomes related to the changes the severity of illness during treatment, indicated that the high levels of APACHE II detected at the third day of the treatment was the important independent variable contributing to the failure of the treatment.As the targeted treatment and the inappropriate empirical treatment were taken as ?the inappropriate initial treatment?, it was 35% in the treatment success group and 64% in the treatment failure group (p= 0,027). The difference may be attributed to the high levels targeted treatment.Antimicrobial treatment starting time was evaluated with respect to the onset of bacteremia and ıt was found that delayed appropriate treatment for ?2 days, was an independent risk for the failure of the treatment.The statistical analyses revealed that ?other concomitant infections? and ?superinfection? were the most frequent reasons in the treatment failures.In conclusion, delayed appropriate treatment was found to be the most important independent reason for treatment failure in patients with the ICU-acquired BSI. In addition, ?other concomitant infections? and ?superinfection? are mostly observed other significant reasons in the treatment failure. This is the first study that evaluates the treatment responses to ICU-acquired BSI in the widest spectrum. The most important factor that limits our study, especially affecting subgroup analysis, is the relatively small number of patients.