Escherichia coli bacteraemias in intensive care unit patients

BACKGROUND: Although bacterial infections are common in critically ill patients, isolation of bacteria from the sample is not always unambiguous. The authors addressed Escherichia coli bacteraemia in patients treated in the Intensive Care Unit in the Teaching Hospital in Gdansk in 2002−2009. METHODS: Using a computer database, the names of Escherichia coli positive patients and dates of blood sampling were found, followed by a retrospective assessment whether positive blood cultures were accompanied by the clinical features of sepsis or asymptomatic bacteraemia. RESULTS: Positive cultures were found in 40 blood samples (36 patients). Bacteraemia was diagnosed in 11, sepsis in 10, severe sepsis in 6 and septic shock in 13 cases. In the bacteraemia group, the condition originated from the gastrointestinal tract — 4 cases; from the lungs — 1; while in 6 cases, the aetiology was not detected. In patients with an infection, the likely source was the gastrointestinal tract — 12 cases; the lungs — 4; and pyothorax — 2. In 11 cases, the aetiology remained unidentified. In 3 patients in the bacteraemia group, cultures of other microorganisms were found to be positive, while there were 4 cases among the septic patients. In the bacteraemia group, 8 patients died in the intensive care unit, without relation to bacteraemia. Amongst septic patients 17 died, including 12 whose death was probably attributable to Escherichia coli infection. CONCLUSIONS: Escherichia coli bacteraemias and infections have been and will remain an everyday problem in hospital wards. The differentiation of asymptomatic bacteraemia from infection is essential for rational antibiotic therapy, which is particularly important considering the increasing resistance of microorganisms.