Update in hospital-acquired bacteremia respiratory infections: experience from the EUROBACT study

Timsit, Jean-Francois, Tabah, Alexis, Koulenti, Despoina, Ruckly, Stephane, Laupland, Kevin B., Garrouste-Orgeas, Maite, Zahar, Jean-Ralph, Blot, Sjin, De Carvalho, Frederico Bruzzi, Paiva, Jose A. and Dimopoulos, George (2014) Update in hospital-acquired bacteremia respiratory infections: experience from the EUROBACT study. Clinical Pulmonary Medicine, 21 1: 9-15. doi:10.1097/CPM.0000000000000014


Author Timsit, Jean-Francois
Tabah, Alexis
Koulenti, Despoina
Ruckly, Stephane
Laupland, Kevin B.
Garrouste-Orgeas, Maite
Zahar, Jean-Ralph
Blot, Sjin
De Carvalho, Frederico Bruzzi
Paiva, Jose A.
Dimopoulos, George
Title Update in hospital-acquired bacteremia respiratory infections: experience from the EUROBACT study
Journal name Clinical Pulmonary Medicine   Check publisher's open access policy
ISSN 1068-0640
1536-5956
Publication date 2014-01
Year available 2014
Sub-type Article (original research)
DOI 10.1097/CPM.0000000000000014
Open Access Status Not Open Access
Volume 21
Issue 1
Start page 9
End page 15
Total pages 7
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Formatted abstract
To describe the characteristics and determinants of outcome of hospital-acquired bloodstream infection (HA-BSI) due to respiratory infection among patients admitted to intensive care units (ICUs). We performed a post hoc analysis of the EUROBACT multicenter cohort study, conducted in 162 ICUs in 24 countries. The HA-BSIs due to candidemia and from mixed respiratory and nonrespiratory sources were excluded. From the overall 1156 included in EUROBACT, 230 patients were classified as having HA-BSI respiratory infections (HA-BSI requiring ICU admission, n=40; ICU-Acquired noninvasively ventilated respiratory BSI, n=30; and ICU-Acquired invasively ventilated BSI, n=160) and were compared with 749 patients with HA-BSI not related to respiratory infections. HA-BSI respiratory infections were more frequently due to gram negatives (76.3% vs. 56.7%, P<0.0001), mainly Acinetobacter baumannii (18.3% vs. 10.4%, P=0.0007), Klebsiella spp. (18.7% vs. 11%, P=0.0013), and were less frequently because of gram-positive cocci (23.3% vs. 41.2%, P<0.0001), with the exception of Staphylococcus aureus (11.3% vs. 9.5%, P=0.39). HA-BSI respiratory infections were more frequently associated with multiple drug-resistant pathogens (53.9% vs. 42.7%, P=0.0003), were more common in medical patients, and were more likely to be ICU-Acquired as compared with nonrespiratory infections. After adjustment for severity and other risk factors, HA-BSI of respiratory origin was a risk factor for day-28 mortality (odds ratio=1.52 [1.02-2.27], P=0.04). Among the cohort of 230 patients with HA-BSI of respiratory origin, those with HA-BSI requiring ICU admission presented more often with septic shock (24/40=60%) as compared with ICU-Acquired HA-BSI episodes occurring in noninvasively (9/30=30%) and invasively (71/160=44%, P=0.04) ventilated patients. Recovered microorganisms were similar between the 3 groups of HA-BSI of respiratory origin. When adjusted for confounding factors, the risk of death was lower for ICU-Acquired HA-BSI occurring among invasive ventilated patients (odds ratio=0.41 [0.19-0.92], P=0.03) than for patients not invasively ventilated before HA-BSI of respiratory origin. The EUROBACT multicenter study confirms that the lung as a respiratory source of infection is associated with more gram-negative resistant pathogen and a poorer prognosis. When associated with BSI, lung infections occurring in noninvasively mechanical ventilated patients are associated with more septic shock and a worse prognosis than patients with bacteremic ventilator-Associated pneumonia.
Keyword Bloodstream infections
Nosocomial pneumonia
Ventilator- associated pneumonia
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Mon, 20 Jun 2016, 17:19:19 EST by Alexs Tabah on behalf of Learning and Research Services (UQ Library)