TY - JOUR
T1 - Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients
T2 - the EUROBACT-2 international cohort study
AU - Tabah, Alexis
AU - Buetti, Niccolò
AU - Staiquly, Quentin
AU - Ruckly, Stéphane
AU - Akova, Murat
AU - Aslan, Abdullah Tarik
AU - Leone, Marc
AU - Conway Morris, Andrew
AU - Bassetti, Matteo
AU - Arvaniti, Kostoula
AU - Lipman, Jeffrey
AU - Ferrer, Ricard
AU - Qiu, Haibo
AU - Paiva, José-Artur
AU - Povoa, Pedro
AU - De Bus, Liesbet
AU - De Waele, Jan
AU - Zand, Farid
AU - Gurjar, Mohan
AU - Alsisi, Adel
AU - Abidi, Khalid
AU - Bracht, Hendrik
AU - Hayashi, Yoshiro
AU - Jeon, Kyeongman
AU - Elhadi, Muhammed
AU - Barbier, François
AU - Timsit, Jean-François
N1 - Funding JdW is a senior clinical investigator funded by the Research Foundation Flan ders (FWO, Ref. 1881020N). ACM is supported by a Medical Research Council Clinician Scientist Fellowship (MR/ V006118/1). NB received a fellowship grant (Grant number: P4P4PM_194449) from the Swiss National Science Founda tion. Research grants were obtained from the European Society of Intensive Care Medicine (ESICM), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) study Group for Infections in Critically Ill Patients (ESGCIP), the Norva Dahlia foundation and the Redclife Hospital Private Practice Trust Fund.
PY - 2023/2
Y1 - 2023/2
N2 - PURPOSE: In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials.METHODS: We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021.RESULTS: 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28.CONCLUSIONS: HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes.
AB - PURPOSE: In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials.METHODS: We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021.RESULTS: 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28.CONCLUSIONS: HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes.
KW - Adult
KW - Humans
KW - Cohort Studies
KW - Prospective Studies
KW - Bacteremia/drug therapy
KW - Cross Infection/prevention & control
KW - Intensive Care Units
KW - Anti-Infective Agents/therapeutic use
KW - Escherichia coli
KW - Hospitals
KW - Carbapenems/therapeutic use
KW - Anti-Bacterial Agents/therapeutic use
U2 - 10.1007/s00134-022-06944-2
DO - 10.1007/s00134-022-06944-2
M3 - Article
C2 - 36764959
SN - 0342-4642
VL - 49
SP - 178
EP - 190
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 2
ER -