Epidemiology and Prognosis of Intensive Care Unit-Acquired Bloodstream Infection

Intensive care unit-acquired bloodstream infections (ICU-BSI) are frequent and are associated with high morbidity and mortality rates. We conducted this study to describe the epidemiology and the prognosis of ICU-BSI in our ICU and to search for factors associated with mortality at 28 days. For this...

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Published in:	The American journal of tropical medicine and hygiene Vol. 103; no. 1; pp. 508 - 514
Main Authors:	Kallel, Hatem, Houcke, Stephanie, Resiere, Dabor, Roy, Michaella, Mayence, Claire, Mathien, Cyrille, Mootien, Joy, Demar, Magalie, Hommel, Didier, Djossou, Felix
Format:	Journal Article
Language:	English
Published:	United States Institute of Tropical Medicine 01-07-2020 American Society of Tropical Medicine and Hygiene The American Society of Tropical Medicine and Hygiene
Subjects:	Adult Anti-Bacterial Agents - therapeutic use Bacteremia - epidemiology Bacteremia - microbiology Bacteremia - mortality Bacteremia - therapy Candidemia - epidemiology Candidemia - mortality Candidemia - therapy Carrier State - epidemiology Catheter-Related Infections - epidemiology Catheter-Related Infections - microbiology Catheter-Related Infections - mortality Catheter-Related Infections - therapy Catheterization, Central Venous - statistics & numerical data Catheterization, Peripheral - statistics & numerical data Coma - epidemiology Comorbidity Cross Infection - epidemiology Cross Infection - microbiology Cross Infection - mortality Cross Infection - therapy Drug Resistance, Multiple, Bacterial Enterobacteriaceae Infections - epidemiology Epidemiology Female French Guiana - epidemiology Humans Intensive care Intensive Care Units Length of Stay - statistics & numerical data Life Sciences Male Middle Aged Mortality Organ Dysfunction Scores Pneumonia, Ventilator-Associated - epidemiology Pneumonia, Ventilator-Associated - therapy Prognosis Renal Replacement Therapy - statistics & numerical data Respiration, Artificial - statistics & numerical data Respiratory Insufficiency - epidemiology Retrospective Studies Shock - epidemiology Staphylococcal Infections - epidemiology Staphylococcal Infections - microbiology Staphylococcal Infections - mortality Staphylococcal Infections - therapy Wounds and Injuries - epidemiology French Guiana
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Summary:	Intensive care unit-acquired bloodstream infections (ICU-BSI) are frequent and are associated with high morbidity and mortality rates. We conducted this study to describe the epidemiology and the prognosis of ICU-BSI in our ICU and to search for factors associated with mortality at 28 days. For this, we retrospectively studied ICU-BSI in the ICU of the Cayenne General Hospital, from January 2013 to June 2019. Intensive care unit-acquired bloodstream infections were diagnosed in 9.5% of admissions (10.3 ICU-BSI/1,000 days). The median delay to the first ICU-BSI was 9 days. The ICU-BSI was primitive in 44% of cases and secondary to ventilator-acquired pneumonia in 25% of cases. The main isolated microorganisms were Enterobacteriaceae in 67.7% of patients. They were extended-spectrum beta-lactamase (ESBL) producers in 27.6% of cases. Initial antibiotic therapy was appropriate in 65.1% of cases. Factors independently associated with ESBL-producing Enterobacteriaceae (ESBL-PE) as the causative microorganism of ICU-BSI were ESBL-PE carriage before ICU-BSI (odds ratio [OR]: 7.273; 95% CI: 2.876-18.392; < 0.000) and prior exposure to fluoroquinolones (OR: 4.327; 95% CI: 1.120-16.728; = 0.034). The sensitivity of ESBL-PE carriage to predict ESBL-PE as the causative microorganism of ICU-BSI was 64.9% and specificity was 81.2%. Mortality at 28 days was 20.6% in the general population. Factors independently associated with mortality at day 28 from the occurrence of ICU-BSI were traumatic category of admission (OR: 0.346; 95% CI: 0.134-0.894; = 0.028) and septic shock on the day of ICU-BSI (OR: 3.317; 95% CI: 1.561-7.050; = 0.002). Mortality rate was independent of the causative organism.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Disclosure: The authors disclose any relationships or support which might be perceived as constituting a conflict of interest. Authors’ addresses: Hatem Kallel, Stephanie Houcke, Michaella Roy, Claire Mayence, Cyrille Mathien, and Didier Hommel, Intensive Care Unit, Cayenne General Hospital, Cayenne, French Guiana, E-mails: kallelhat@yahoo.fr, stephanie.houcke@ch-cayenne.fr, michaella.roy@ch-cayenne.fr, claire.mayence@ch-cayenne.fr, cyrille.mathien@ch-cayenne.fr, and didier.hommel@ch-cayenne.fr. Dabor Resiere, Intensive Care Unit, Martinique University Hospital, Fort-de-France, Martinique, E-mail: dabor.resiere@chu-martinique.fr. Joy Mootien, Intensive Care Unit, GHRSMA, Mulhouse, France, E-mail: joy.mootien@ch-mulhouse.fr. Magalie Demar, Laboratory of Microbiology, Cayenne General Hospital, Cayenne, French Guiana, E-mail: magalie.demar@ch-cayenne.fr. Felix Djossou, Tropical and Infectious Diseases Department, Cayenne General Hospital, Cayenne, French Guiana, E-mail: felix.djossou@ch-cayenne.fr.
ISSN:	0002-9637 1476-1645
DOI:	10.4269/ajtmh.19-0877