Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study

• Type: Article in International Scientific Journal
• Date: 2012

Authors

Tabah, A (Author) Other; Koulenti, D (Author) Other; Laupland, K (Author) Other; Misset, B (Author) Other; Valles, J (Author) Other; de Carvalho, FB (Author) Other; Paiva, J-A (Author) FMUP; Cakar, N (Author) Other; Ma, XC (Author) Other; Eggimann, P (Author) Other; Antonelli, M (Author) Other; Bonten, MJM (Author) Other; Csomos, A (Author) Other; Krueger, WA (Author) Other; Mikstacki, A (Author) Other; Lipman, J (Author) Other; Depuydt, P (Author) Other; Vesin, A (Author) Other; Garrouste Orgeas, M (Author) Other; Zahar, JR (Author) Other; Blot, S (Author) Other; Carlet, J (Author) Other; Brun Buisson, C (Author) Other; Martin, C (Author) Other; Rello, J (Author) Other; Dimopoulos, G (Author) Other; Timsit, JF (Author) Other

Journal

Title: Intensive Care Medicine

Vol. 38

Pages: 1930-1945

ISSN: 0342-4642

Publisher: Springer Nature

Indexing

ISI Web of Knowledge - 211 Citations

Scopus - 223 Citations

Other information

Authenticus ID: P-002-32K

DOI: 10.1007/s00134-012-2695-9

Abstract (EN): The recent increase in drug-resistant micro-organisms complicates the management of hospital-acquired bloodstream infections (HA-BSIs). We investigated the epidemiology of HA-BSI and evaluated the impact of drug resistance on outcomes of critically ill patients, controlling for patient characteristics and infection management. A prospective, multicentre non-representative cohort study was conducted in 162 intensive care units (ICUs) in 24 countries. We included 1,156 patients [mean +/- A standard deviation (SD) age, 59.5 +/- A 17.7 years; 65 % males; mean +/- A SD Simplified Acute Physiology Score (SAPS) II score, 50 +/- A 17] with HA-BSIs, of which 76 % were ICU-acquired. Median time to diagnosis was 14 [interquartile range (IQR), 7-26] days after hospital admission. Polymicrobial infections accounted for 12 % of cases. Among monomicrobial infections, 58.3 % were gram-negative, 32.8 % gram-positive, 7.8 % fungal and 1.2 % due to strict anaerobes. Overall, 629 (47.8 %) isolates were multidrug-resistant (MDR), including 270 (20.5 %) extensively resistant (XDR), and 5 (0.4 %) pan-drug-resistant (PDR). Micro-organism distribution and MDR occurrence varied significantly (p < 0.001) by country. The 28-day all-cause fatality rate was 36 %. In the multivariable model including micro-organism, patient and centre variables, independent predictors of 28-day mortality included MDR isolate [odds ratio (OR), 1.49; 95 % confidence interval (95 %CI), 1.07-2.06], uncontrolled infection source (OR, 5.86; 95 %CI, 2.5-13.9) and timing to adequate treatment (before day 6 since blood culture collection versus never, OR, 0.38; 95 %CI, 0.23-0.63; since day 6 versus never, OR, 0.20; 95 %CI, 0.08-0.47). MDR and XDR bacteria (especially gram-negative) are common in HA-BSIs in critically ill patients and are associated with increased 28-day mortality. Intensified efforts to prevent HA-BSIs and to optimize their management through adequate source control and antibiotic therapy are needed to improve outcomes.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 16