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Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients

2023-02Artigo científico Acesso aberto
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dc.contributor.authorTabah, Alexis
dc.contributor.authorBuetti, Niccolò
dc.contributor.authorStaiquly, Quentin
dc.contributor.authorRuckly, Stéphane
dc.contributor.authorAkova, Murat
dc.contributor.authorAslan, Abdullah Tarik
dc.contributor.authorLeone, Marc
dc.contributor.authorConway Morris, Andrew
dc.contributor.authorBassetti, Matteo
dc.contributor.authorArvaniti, Kostoula
dc.contributor.authorLipman, Jeffrey
dc.contributor.authorFerrer, Ricard
dc.contributor.authorQiu, Haibo
dc.contributor.authorPaiva, José-Artur
dc.contributor.authorPovoa, Pedro
dc.contributor.authorDe Bus, Liesbet
dc.contributor.authorPovoa, Pedro
dc.contributor.authorDe Waele, Jan
dc.contributor.authorZand, Farid
dc.contributor.authorGurjar, Mohan
dc.contributor.authorAlsisi, Adel
dc.contributor.authorAbidi, Khalid
dc.contributor.authorBracht, Hendrik
dc.contributor.authorHayashi, Yoshiro
dc.contributor.authorJeon, Kyeongman
dc.contributor.authorElhadi, Muhammed
dc.contributor.authorBarbier, François
dc.contributor.authorTimsit, Jean-François
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblSpringer
dc.date.accessioned2023-03-13T22:25:48Z
dc.date.available2023-03-13T22:25:48Z
dc.date.issued2023-02
dc.descriptionFunding 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.
dc.description.abstractPURPOSE: 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.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent13
dc.format.extent1256717
dc.identifier.doi10.1007/s00134-022-06944-2
dc.identifier.issn0342-4642
dc.identifier.otherPURE: 54520998
dc.identifier.otherPURE UUID: 9a84ea88-229d-4275-ae85-7a8dd362834f
dc.identifier.otherPubMed: 36764959
dc.identifier.otherPubMedCentral: PMC9916499
dc.identifier.otherScopus: 85148678267
dc.identifier.urihttp://hdl.handle.net/10362/150476
dc.identifier.urlhttps://www.scopus.com/pages/publications/85148678267
dc.language.isoeng
dc.peerreviewedyes
dc.subjectAdult
dc.subjectHumans
dc.subjectCohort Studies
dc.subjectProspective Studies
dc.subjectBacteremia/drug therapy
dc.subjectCross Infection/prevention & control
dc.subjectIntensive Care Units
dc.subjectAnti-Infective Agents/therapeutic use
dc.subjectEscherichia coli
dc.subjectHospitals
dc.subjectCarbapenems/therapeutic use
dc.subjectAnti-Bacterial Agents/therapeutic use
dc.subjectbloodstream infection
dc.subjecthospital-acquired
dc.subjectantibiotic resistance
dc.subjectbacteremia
dc.subjectCritical Care and Intensive Care Medicine
dc.titleEpidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patientsen
dc.title.subtitlethe EUROBACT-2 international cohort studyen
dc.typejournal article
degois.publication.firstPage178
degois.publication.issue2
degois.publication.lastPage190
degois.publication.titleIntensive Care Medicine
degois.publication.volume49
dspace.entity.typePublication
person.familyNamePovoa
person.givenNamePedro
person.identifier.ciencia-id0C16-5CF9-9238
person.identifier.orcid0000-0002-7069-7304
person.identifier.scopus-author-id6602772147
rcaap.rightsopenAccess
relation.isAuthorOfPublication04ec38ba-be1e-46e5-8007-0e65a557d0f4
relation.isAuthorOfPublication.latestForDiscovery04ec38ba-be1e-46e5-8007-0e65a557d0f4

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