Consistent microorganism isolated from blood and abdominal drain cultures is an independent risk factor for mortality in critically ill gastrointestinal fistula patients with bloodstream infection: an initial retrospective study

Abstract

Abstract Background Bloodstream infection (BSI) is a common complication of gastrointestinal fistula, leading to adverse outcomes. Whether a bloodstream infection is caused by an ectopic intra-abdominal infection, i.e. whether it is intra-abdominal/intestinal borne, may affect the patient's prognosis. In this study, we will analyze the value of consistency between blood culture and abdominal drain culture in predicting adverse outcomes in critically ill gastrointestinal fistula patients with BSI. Material and methods A retrospective analysis was performed in 295 patients with gastrointestinal fistula recruited in intensive care unit (ICU) of Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine. In which, a highly selected population who were identified with BSI were involved and divided into a consistent group (one or more microorganisms isolated from blood cultures were same with microorganisms isolated from abdominal drain cultures) and an inconsistent group (all microorganisms isolated from blood cultures were different with microorganisms isolated from abdominal drain cultures). Results Consistent group accounted for 41.57% (37/89) of all BSI patients with significantly higher in-hospital mortality (48.65% vs. 15.38%, P = 0.001). Meanwhile, a 90-days prognosis analysis indicated that consistent group showed inferior survival benefits than inconsistent group. Consistent group was more likely to sufferer from Gram-negative bacteria (P = 0.001) and fungi (P = 0.031) infection in blood cultures. Frequency of Acinetobacter baumannii and Enterococcus were significantly higher in consistent group, both in blood and abdominal drain cultures. In multivariate analysis, consistent microorganism isolated from blood and abdominal drain cultures (OR = 4.320 [1.536–12.153]; P = 0.006) and vasopressors (OR = 6.784 [1.416–32.488]; P = 0.017) were identified as independent risk factors for mortality. Conclusion Consistent microorganism isolated from blood and abdominal drain cultures is an independent risk factor for mortality in critically ill gastrointestinal fistula patients with BSI.