Tabah, AlexisBuetti, NiccolòStaiquly, QuentinRuckly, StéphaneAkova, MuratAslan, Abdullah TarikLeone, MarcConway Morris, AndrewBassetti, MatteoArvaniti, KostoulaLipman, JeffreyFerrer, RicardQiu, HaiboPaiva, José-ArturPovoa, PedroDe Bus, LiesbetPovoa, PedroDe Waele, JanZand, FaridGurjar, MohanAlsisi, AdelAbidi, KhalidBracht, HendrikHayashi, YoshiroJeon, KyeongmanElhadi, MuhammedBarbier, FrançoisTimsit, Jean-François2023-03-132023-03-132023-020342-4642PURE: 54520998PURE UUID: 9a84ea88-229d-4275-ae85-7a8dd362834fPubMed: 36764959PubMedCentral: PMC9916499Scopus: 85148678267http://hdl.handle.net/10362/150476Funding 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.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.131256717engAdultHumansCohort StudiesProspective StudiesBacteremia/drug therapyCross Infection/prevention & controlIntensive Care UnitsAnti-Infective Agents/therapeutic useEscherichia coliHospitalsCarbapenems/therapeutic useAnti-Bacterial Agents/therapeutic usebloodstream infectionhospital-acquiredantibiotic resistancebacteremiaCritical Care and Intensive Care Medicinejournal article10.1007/s00134-022-06944-2https://www.scopus.com/pages/publications/85148678267