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

• Published in: Intensive care medicine Vol. 38; no. 12; pp. 1930 - 1945
• Main Authors: Tabah, Alexis, Koulenti, Despoina, Laupland, Kevin, Misset, Benoit, Valles, Jordi, Bruzzi de Carvalho, Frederico, Paiva, José Artur, Çakar, Nahit, Ma, Xiaochun, Eggimann, Philippe, Antonelli, Massimo, Bonten, Marc J. M., Csomos, Akos, Krueger, Wolfgang A., Mikstacki, Adam, Lipman, Jeffrey, Depuydt, Pieter, Vesin, Aurélien, Garrouste-Orgeas, Maité, Zahar, Jean-Ralph, Blot, Stijn, Carlet, Jean, Brun-Buisson, Christian, Martin, Claude, Rello, Jordi, Dimopoulos, Georges, Timsit, Jean-François
• Format: Journal Article Web Resource
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-12-2012; Springer; Springer Nature B.V
• Subjects: Analysis; Anesthesia & intensive care; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Anesthésie & soins intensifs; Anti-Infective Agents - pharmacology; Anti-Infective Agents - therapeutic use; Anti-Infective Agents/pharmacology/therapeutic use; Antibiotics; Bacteremia - drug therapy; Bacteremia - epidemiology; Bacteremia - microbiology; Bacteremia - prevention & control; Bacteremia/drug therapy/epidemiology/microbiology/prevention & control; Biological and medical sciences; Clinical death. Palliative care. Organ gift and preservation; Cohort analysis; Critical care; Critical Care Medicine; Cross Infection - drug therapy; Cross Infection - epidemiology; Cross Infection - microbiology; Cross Infection - prevention & control; Cross Infection/drug therapy/epidemiology/microbiology/prevention & control; Drug resistance; Drug resistance in microorganisms; Drug Resistance, Microbial; Emergency Medicine; Epidemiology; Europe - epidemiology; Female; Fungemia - drug therapy; Fungemia - epidemiology; Fungemia - microbiology; Fungemia - prevention & control; Fungemia/drug therapy/epidemiology/microbiology/prevention & control; Health aspects; Hospital Mortality; Hospital patients; Hospitals; Human health sciences; Humans; Intensive; Intensive care; Intensive care medicine; Intensive Care Units; Logistic Models; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Mortality; Multivariate Analysis; Nosocomial infections; Pain Medicine; Patients; Pediatrics; Physiological aspects; Pneumology/Respiratory System; Prospective Studies; Risk Factors; Sciences de la santé humaine; Special Article; Europe; France; Istanbul Turkey; Turkey; Belgium; China; Paris France; Spain; Hospital acquired bloodstream infections; Prognosis; Critically ill patients; Antibiotic therapy; Multilevel models; Extensively resistant bacterias; Human; Nosocomial infection; Intensive care; Critically ill; Intensive care unit; Antibiotic; Treatment; Cohort study; Resuscitation
• ISSN: 0342-4642; 1432-1238; 1432-1238
• DOI: 10.1007/s00134-012-2695-9

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.