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- Title
Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study.
- Authors
Tabah, Alexis; Koulenti, Despoina; Laupland, Kevin; Misset, Benoit; Valles, Jordi; Bruzzi de Carvalho, Frederico; Paiva, José; Çakar, Nahit; Ma, Xiaochun; Eggimann, Philippe; Antonelli, Massimo; Bonten, Marc; Csomos, Akos; Krueger, Wolfgang; Mikstacki, Adam; Lipman, Jeffrey; Depuydt, Pieter; Vesin, Aurélien; Garrouste-Orgeas, Maité; Zahar, Jean-Ralph
- Abstract
Purpose: 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. Methods: A prospective, multicentre non-representative cohort study was conducted in 162 intensive care units (ICUs) in 24 countries. Results: We included 1,156 patients [mean ± standard deviation (SD) age, 59.5 ± 17.7 years; 65 % males; mean ± SD Simplified Acute Physiology Score (SAPS) II score, 50 ± 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). Conclusions: 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.
- Subjects
NOSOCOMIAL infections; CRITICALLY ill; EPIDEMIOLOGY; DRUG resistance; HEALTH outcome assessment; INTENSIVE care units; COHORT analysis
- Publication
Intensive Care Medicine, 2012, Vol 38, Issue 12, p1930
- ISSN
0342-4642
- Publication type
Article
- DOI
10.1007/s00134-012-2695-9