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

• Tipo: Artigo em Revista Científica Internacional
• Data: 2012

Autores

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

Revista

Título: Intensive Care Medicine

Vol. 38

Páginas: 1930-1945

ISSN: 0342-4642

Editora: Springer Nature

Indexação

ISI Web of Knowledge - 211 Citações

Scopus - 223 Citações

Outras Informações

ID Authenticus: 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.

Idioma: Inglês

Tipo (Avaliação Docente): Científica

Nº de páginas: 16