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

Tabah, Alexis, Koulenti, Despoina, Laupland, Kevin, Misset, Benoit, Valles, Jordi, de Carvalho, Frederico Bruzzi, Paiva, Jose Artur, Cakar, Nahit, Ma, Xiaochun, Eggimann, Philippe, Antonelli, Massimo, Bonten, Marc J. M., Csomos, Akos, Krueger, Wolfgang A., Mikstacki, Adam, Lipman, Jeffrey, Depuydt, Pieter, Vesin, Aurelien, Garrouste-Orgeas, Maite, Zahar, Jean-Ralph, Blot, Stijn, Carlet, Jean, Brun-Buisson, Christian, Martin, Claude, Rello, Jordi, Dimopoulos, Georges, Timsit, Jean-Francois and EUROBACT Study Group (2012) Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study. Intensive Care Medicine, 38 12: 1930-1945. doi:10.1007/s00134-012-2695-9

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Author Tabah, Alexis
Koulenti, Despoina
Laupland, Kevin
Misset, Benoit
Valles, Jordi
de Carvalho, Frederico Bruzzi
Paiva, Jose Artur
Cakar, Nahit
Ma, Xiaochun
Eggimann, Philippe
Antonelli, Massimo
Bonten, Marc J. M.
Csomos, Akos
Krueger, Wolfgang A.
Mikstacki, Adam
Lipman, Jeffrey
Depuydt, Pieter
Vesin, Aurelien
Garrouste-Orgeas, Maite
Zahar, Jean-Ralph
Blot, Stijn
Carlet, Jean
Brun-Buisson, Christian
Martin, Claude
Rello, Jordi
Dimopoulos, Georges
Timsit, Jean-Francois
EUROBACT Study Group
Total Author Count Override 27
Title Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study
Journal name Intensive Care Medicine   Check publisher's open access policy
ISSN 0342-4642
1432-1238
Publication date 2012-12
Sub-type Article (original research)
DOI 10.1007/s00134-012-2695-9
Open Access Status
Volume 38
Issue 12
Start page 1930
End page 1945
Total pages 16
Place of publication Heidelberg, Germany
Publisher Springer
Collection year 2013
Language eng
Formatted 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.
Keyword Hospital acquired bloodstream infections
Critically ill patients
Antibiotic therapy
Prognosis
Multilevel models
Extensively resistant bacterias
Critically ill patients
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Medicine Publications
 
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Created: Mon, 17 Dec 2012, 17:22:36 EST by Sia Athanasas on behalf of School of Medicine