PurposeIn 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.MethodsWe 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.Results2600 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.ConclusionsHA-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.

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Montrucchio, Giorgia
2023-01-01

Abstract

PurposeIn 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.MethodsWe 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.Results2600 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.ConclusionsHA-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.
2023
49
2
178
190
antibiotic resistance; bacteremia; bloodstream infection; hospital-acquired
Tabah, Alexis; Buetti, Niccolò; Staiquly, Quentin; Ruckly, Stéphane; Akova, Murat; Aslan, Abdullah Tarik; Leone, Marc; Conway Morris, Andrew; Bassetti, Matteo; Arvaniti, Kostoula; Lipman, Jeffrey; Ferrer, Ricard; Qiu, Haibo; Paiva, José-Artur; Povoa, Pedro; De Bus, Liesbet; De Waele, Jan; Zand, Farid; Gurjar, Mohan; Alsisi, Adel; Abidi, Khalid; Bracht, Hendrik; Hayashi, Yoshiro; Jeon, Kyeongman; Elhadi, Muhammed; Barbier, François; Timsit, Jean-François; Tabah, Alexis; Pollock, Hamish; Margetts, Ben; Young, Meredith; Bhadange, Neeraj; Tyler, Steven; Ledtischke, Anne; Finnis, Mackenzie; Ledtischke, Anne; Finnis, Mackenzie; Dwivedi, Jyotsna; Saxena, Manoj; Biradar, Vishwanath; Soar, Natalie; Sarode, Vineet; Brewster, David; Regli, Adrian; Weeda, Elizabeth; Ahmed, Samiul; Fourie, Cheryl; Laupland, Kevin; Ramanan, Mahesh; Walsham, James; Meyer, Jason; Litton, Edward; Palermo, Anna Maria; Yap, Timothy; Eroglu, Ege; Attokaran, Antony George; Jaramillo, C’havala; Nafees, Khalid Mahmood Khan; Rashid, Nurhikmahtul Aqilah Haji Abd; Walid, Haji Adi Muhamad Ibnu; Mon, Tomas; Moorthi, P. Dhakshina; Sudhirchandra, Shah; Sridharan, Dhadappa Damodar; Haibo, Qiu; Jianfeng, Xie; Wei-Hua, Lu; Zhen, Wang; Qian, Chuanyun; Luo, Jili; Chen, Xiaomei; Wang, Hao; Zhao, Peng; Zhao, Juan; Wusi, Qiu; Mingmin, Chen; Xu, Lei; Yin, Chengfen; Wang, Ruilan; Wang, Jinfeng; Yin, Yongjie; Zhang, Min; Ye, Jilu; Hu, Chungfang; Zhou, Suming; Huang, Min; Yan, Jing; Wang, Yan; Qin, Bingyu; Ye, Ling; Weifeng, Xie; Peije, Li; Geng, Nan; Hayashi, Yoshiro; Karumai, Toshiyuki; Yamasaki, Masaki; Hashimoto, Satoru; Hosokawa, Koji; Makino, Jun; Matsuyoshi, Takeo; Kuriyama, Akira; Shigemitsu, Hidenobu; Mishima, Yuka; Nagashima, Michio; Yoshida, Hideki; Fujitani, Shigeki; Omori, Koichiro; Rinka, Hiroshi; Saito, Hiroki; Atobe, Kaori; Kato, Hideaki; Takaki, Shunsuke; Hasan, M. Shahnaz; Jamaluddin, Muhamad Fadhil Hadi; Pheng, Lee See; Visvalingam, Sheshendrasurian; Liew, Mun Thing; Wong, Siong Ling Danny; Fong, Kean Khang; Rahman, Hamizah Bt Abdul; Noor, Zuraini Md; Tong, Lee Kok; Azman, Abd. Hamid; Mazlan, Mohd Zulfakar; Ali, Saedah; Jeon, Kyeongman; Lee, Sang-Min; Park, Sunghoon; Park, Seung Yong; Lim, Sung Yoon; Goh, Qing Yuan; Ng, Shin Yi; Lie, Sui An; Kwa, Andrea Lay Hoon; Goh, Ken Junyang; Li, Andrew Yunkai; Ong, Caroline Yu Ming; Lim, Jia Yan; Quah, Jessica Lishan; Ng, Kangqi; Ng, Louis Xiang Long; Yeh, Yu Chang; Chou, Nai-Kuan; Cia, Cong-Tat; Hu, Ting-Yu; Kuo, Li-Kuo; Ku, Shih-Chi; Wongsurakiat, Phunsup; Apichatbutr, Yutthana; Chiewroongroj, Supattra; Nadeem, Rashid; Houfi, Ashraf El; Alsisi, Adel; Elhadidy, Amr; Barsoum, Mina; Osman, Nermin; Mostafa, Tarek; Elbahnasawy, Mohamed; Saber, Ahmed; Aldhalia, Amer; Elmandouh, Omar; Elsayed, Ahmed; Elbadawy, Merihan A.; Awad, Ahmed K.; Hemead, Hanan M.; Zand, Farid; Ouhadian, Maryam; Borsi, Seyed Hamid; Mehraban, Zahra; Kashipazha, Davood; Ahmadi, Fatemeh; Savaie, Mohsen; Soltani, Farhad; Rashidi, Mahboobeh; Baghbanian, Reza; Javaherforoosh, Fatemeh; Amiri, Fereshteh; Kiani, Arash; Zargar, Mohammad Amin; Mahmoodpoor, Ata; Aalinezhad, Fatemeh; Dabiri, Gholamreza; Sabetian, Golnar; Sarshad, Hakimeh; Masjedi, Mansoor; Tajvidi, Ramin; Tabatabaei, Seyed Mohammad Nasirodin; Ahmed, Abdullah Khudhur; Singer, Pierre; Kagan, Ilya; Rigler, Merav; Belman, Daniel; Levin, Phillip; Harara, Belal; Diab, Adei; Abilama, Fayez; Ibrahim, Rebecca; Fares, Aya; Buimsaedah, Ahmad; Gamra, Marwa; Aqeelah, Ahmed; AliAli, Almajdoub Mohammed; Homaidan, Ahmed Gaber Sadik; Almiqlash, Bushray; Bilkhayr, Hala; Bouhuwaish, Ahmad; Taher, Ahmed Sa; Abdulwahed, Eman; Abousnina, Fathi A.; Hdada, Aisha Khaled; Jobran, Rania; Hasan, Hayat Ben; Hasan, Rabab Shaban Ben; Serghini, Issam; Seddiki, Rachid; Boukatta, Brahim; Kanjaa, Nabil; Mouhssine, Doumiri; Wajdi, Maazouzi Ahmed; Dendane, Tarek; Zeggwagh, Amine Ali; Housni, Brahim; Younes, Oujidi; Hachimi, Abdelhamid; Ghannam, A.; Belkhadir, Z.; Amro, Sarah; Jayyab, Mustafa Abu; Hssain, Ali Ait; Elbuzidi, Abdurahaman; Karic, Edin; Lance, Marcus; Nissar, Shaikh; Sallam, Hend; Elrabi, Omar; Almekhlafi, Ghaleb A.; Awad, Maher; Aljabbary, Ahmed; Chaaban, Mohammad Karam; Abu-Sayf, Natalia; Al-Jadaan, Mohammad; Bakr, Lubna; Bouaziz, Mounir; Turki, Olfa; Sellami, Walid; Centeno, Pablo; Morvillo, Lic Natalia; Acevedo, José Oscar; Lopez, Patricia Mabel; Fernández, Rubén; Segura, Matías; Aparicio, Dra Marta; Alonzo, Microbiologa Irene; Nuccetelli, Yanina; Montefiore, Pablo; Reyes, Luis Felipe; Reyes, Luis Felipe; Ñamendys-Silva, Silvio A.; Romero-Gonzalez, Juan P.; Hermosillo, Mariana; Castillo, Roberto Alejandro; Leal, Jesús Nicolás Pantoja; Aguilar, Candy Garcia; Herrera, Mara Ocotlan Gonzalez; Villafuerte, Missael Vladimir Espinoza; Lomeli-Teran, Manuel; Dominguez-Cherit, Jose G.; Davalos-Alvarez, Adrian; Ñamendys-Silva, Silvio A.; Sánchez-Hurtado, Luis; Tejeda-Huezo, Brigitte; Perez-Nieto, Orlando R.; Tomas, Ernesto Deloya; De Bus, Liesbet; De Waele, Jan; Hollevoet, Isabelle; Denys, Wouter; Bourgeois, Marc; Vanderhaeghen, Sofie F. M.; Mesland, Jean-Baptiste; Henin, Pierre; Haentjens, Lionel; Biston, Patrick; Noel, Cindérella; Layos, Nathalie; Misset, Benoît; De Schryver, Nicolas; Serck, Nicolas; Wittebole, Xavier; De Waele, Elisabeth; Opdenacker, Godelive; Kovacevic, Pedja; Zlojutro, Biljana; Custovic, Aida; Filipovic-Grcic, Ina; Radonic, Radovan; Brajkovic, Ana Vujaklija; Persec, Jasminka; Sakan, Sanja; Nikolic, Mario; Lasic, Hrvoje; Leone, Marc; Arbelot, Charlotte; Timsit, Jean-François; Patrier, Juliette; Zappela, N.; Montravers, P.; Dulac, Thierry; Castanera, Jérémy; Auchabie, Johann; Le Meur, Anthony; Marchalot, A.; Beuzelin, M.; Massri, Alexandre; Guesdon, Charlotte; Escudier, Etienne; Mateu, Philippe; Rosman, Jérémy; Leroy, Olivier; Alfandari, Serge; Nica, Alexandru; Souweine, Bertrand; Coupez, Elisabeth; Duburcq, Thibault; Kipnis, Eric; Bortolotti, Perrine; Le Souhaitier, Mathieu; Mira, Jean-Paul; Garcon, Pierre; Duprey, Matthieu; Thyrault, Martial; Paulet, Rémi; Philippart, François; Tran, Marc; Bruel, Cédric; Weiss, Emmanuel; Janny, Sylvie; Foucrier, Arnaud; Perrigault, Pierre-François; Djanikian, Flora; Barbier, François; Gainnier, Marc; Bourenne, Jérémy; Louis, Guillaume; Smonig, Roland; Argaud, Laurent; Baudry, Thomas; Dessap, Armand Mekonted; Razazi, Keyvan; Kalfon, Pierre; Badre, Gaëtan; Larcher, Romaric; Lefrant, Jean-Yves; Roger, Claire; Sarton, Benjamine; Silva, Stein; Demeret, Sophie; Le Guennec, Loïc; Siami, Shidasp; Aparicio, Christelle; Voiriot, Guillaume; Fartoukh, Muriel; Dahyot-Fizelier, Claire; Imzi, Nadia; Klouche, Kada; Bracht, Hendrik; Hoheisen, Sandra; Bloos, Frank; Thomas-Rueddel, Daniel; Petros, Sirak; Pasieka, Bastian; Dubler, Simon; Schmidt, Karsten; Gottschalk, Antje; Wempe, Carola; Lepper, Philippe; Metz, Carlos; Viderman, Dmitriy; Ymbetzhanov, Yerlan; Mugazov, Miras; Bazhykayeva, Yelena; Kaligozhin, Zhannur; Babashev, Baurzhan; Merenkov, Yevgeniy; Temirov, Talgat; Arvaniti, Kostoula; Smyrniotis, Dimitrios; Psallida, Vasiliki; Fildisis, Georgios; Soulountsi, Vasiliki; Kaimakamis, Evangelos; Iasonidou, Cristina; Papoti, Sofia; Renta, Foteini; Vasileiou, Maria; Romanou, Vasiliki; Koutsoukou, Vasiliki; Matei, Mariana Kristina; Moldovan, Leora; Karaiskos, Ilias; Paskalis, Harry; Marmanidou, Kyriaki; Papanikolaou, M.; Kampolis, C.; Oikonomou, Marina; Kogkopoulos, Evangelos; Nikolaou, Charikleia; Sakkalis, Anastasios; Chatzis, Marinos; Georgopoulou, Maria; Efthymiou, Anna; Chantziara, Vasiliki; Sakagianni, Aikaterini; Athanasa, Zoi; Papageorgiou, Eirini; Ali, Fadi; Dimopoulos, Georges; Almiroudi, Mariota Panagiota; Malliotakis, Polychronis; Marouli, Diamantina; Theodorou, Vasiliki; Retselas, Ioannis; Kouroulas, Vasilios; Papathanakos, Georgios; Montrucchio, Giorgia; Sales, Gabriele; De Pascale, Gennaro; Montini, Luca Maria; Carelli, Simone; Vargas, Joel; Di Gravio, Valentina; Giacobbe, Daniele Roberto; Gratarola, Angelo; Porcile, Elisa; Mirabella, Michele; Daroui, Ivan; Lodi, Giovanni; Zuccaro, Francesco; Schlevenin, Maria Grazia; Pelosi, Paolo; Battaglini, Denise; Cortegiani, Andrea; Ippolito, Mariachiara; Bellina, Davide; Di Guardo, Andrea; Pelagalli, Lorella; Covotta, Marco; Rocco, Monica; Fiorelli, Silvia; Cotoia, Antonella; Rizzo, Anna Chiara; Mikstacki, Adam; Tamowicz, Barbara; Komorowska, Irmina Kaptur; Szczesniak, Anna; Bojko, Jozef; Kotkowska, Anna; Walczak-Wieteska, Paulina; Wasowska, Dominika; Nowakowski, Tomasz; Broda, Hanna; Peichota, Mariusz; Pietraszek-Grzywaczewska, Iwona; Martin-Loeches, Ignacio; Bisanti, Alessandra; Cartoze, Nuno; Pereira, Tiago; Guimarães, Nádia; Alves, Madalena; Marques, Ana Josefina Pinheiro; Pinto, Ana Rios; Krystopchuk, Andriy; Teresa, Ana; de Figueiredo, António Manuel Pereira; Botelho, Isabel; Duarte, Tiago; Costa, Vasco; Cunha, Rui Pedro; Molinos, Elena; da Costa, Tito; Ledo, Sara; Queiró, Joana; Pascoalinho, Dulce; Nunes, Cristina; Moura, José Pedro; Pereira, Énio; Mendes, António Carvalho; Valeanu, Liana; Bubenek-Turconi, Serban; Grintescu, Ioana Marina; Cobilinschi, Cristian; Filipescu, Daniela Carmen; Predoi, Cornelia Elena; Tomescu, Dana; Popescu, Mihai; Marcu, Alexandra; Grigoras, Ioana; Lungu, Olguta; Gritsan, Alexey; Anderzhanova, Anastasia; Meleshkina, Yulia; Magomedov, Marat; Zubareva, Nadezhda; Tribulev, Maksim; Gaigolnik, Denis; Eremenko, Aleksandr; Vistovskaya, Natala; Chukina, Maria; Belskiy, Vladislav; Furman, Mikhail; Rocca, Ricard Ferrer; Martinez, Maria; Casares, Vanessa; Vera, Paula; Flores, Matias; Amerigo, Joaquin Amador; Arnillas, Maria Pilar Gracia; Bermudez, Rosana Munoz; Armestar, Fernando; Catalan, Beatriz; Roig, Regina; Raguer, Laura; Quesada, María Dolores; Santos, Emilio Diaz; Gomà, Gemma; Ubeda, Alejandro; Salgado, Dra Maria; Espina, Lorena Forcelledo; Prieto, Emilio Garcia; Asensio, Dra Mj; Rodriguez, Dra M.; Maseda, Emilio; De La Rica, Alejandro Suarez; Ayestaran, J. Ignacio; Novo, Mariana; Blasco-Navalpotro, Miguel Angel; Gallego, Alberto Orejas; Sjövall, Fredrik; Spahic, Dzana; Svensson, Carl Johan; Haney, Michael; Edin, Alicia; Åkerlund, Joyce; De Geer, Lina; Prazak, Josef; Jakob, Stephan; Pagani, Jl; Abed-Maillard, S.; Akova, Murat; Aslan, Abdullah Tarik; Timuroglu, Arif; Kocagoz, Sesin; Kusoglu, Hulya; Mehtap, Selcuk; Ceyhun, Solakoğlu; Altintas, Neriman Defne; Talan, Leyla; Kayaaslan, Bircan; Kalem, Ayşe Kaya; Kurt, Ibrahim; Telli, Murat; Ozturk, Barcin; Erol, Çiğdem; Demiray, Emine Kubra Dindar; Çolak, Sait; Akbas, Türkay; Gundogan, Kursat; Sari, Ali; Agalar, Canan; Çolak, Onur; Baykam, Nurcan N.; Akdogan, Ozlem O.; Yilmaz, Mesut; Tunay, Burcu; Cakmak, Rumeysa; Saltoglu, Nese; Karaali, Ridvan; Koksal, Iftihar; Aksoy, Firdevs; Eroglu, Ahmet; Saracoglu, Kemal Tolga; Bilir, Yeliz; Guzeldag, Seda; Ersoz, Gulden; Evik, Guliz; Sungurtekin, Hulya; Ozgen, Cansu; Erdoğan, Cem; Gürbüz, Yunus; Altin, Nilgün; Bayindir, Yasar; Ersoy, Yasemin; Goksu, Senay; Akyol, Ahmet; Batirel, Ayse; Aktas, Sabahat Cagan; Morris, Andrew Conway; Routledge, Matthew; Morris, Andrew Conway; Ercole, Ari; Antcliffe, David; Rojo, Roceld; Tizard, Kate; Faulkner, Maria; Cowton, Amanda; Kent, Melanie; Raj, Ashok; Zormpa, Artemis; Tinaslanidis, George; Khade, Reena; Torlinski, Tomasz; Mulhi, Randeep; Goyal, Shraddha; Bajaj, Manan; Soltan, Marina; Yonan, Aimee; Dolan, Rachael; Johnson, Aimee; Macfie, Caroline; Lennard, James; Templeton, Maie; Arias, Sonia Sousa; Franke, Uwe; Hugill, Keith; Angell, Hollie; Parcell, Benjamin J.; Cobb, Katherine; Cole, Stephen; Smith, Tim; Graham, Clive; Cerman, Jaroslav; Keegan, Allison; Ritzema, Jenny; Sanderson, Amanda; Roshdy, Ashraf; Szakmany, Tamas; Baumer, Tom; Longbottom, Rebecca; Hall, Daniel; Tatham, Kate; Loftus, S.; Husain, A.; Black, E.; Jhanji, S.; Baikady, R. Rao; Mcguigan, Peter; Mckee, Rachel; Kannan, Santhana; Antrolikar, Supriya; Marsden, Nicholas; Torre, Valentina Della; Banach, Dorota; Zaki, Ahmed; Jackson, Matthew; Chikungwa, Moses; Attwood, Ben; Patel, Jamie; Tilley, Rebecca E.; Humphreys, Miss Sally K.; Renaud, Paul Jean; Sokhan, Anton; Burma, Yaroslava; Sligl, Wendy; Baig, Nadia; McCoshen, Lorena; Kutsogiannis, Demetrios J.; Sligl, Wendy; Thompson, Patricia; Hewer, Tayne; Rabbani, Raihan; Huq, Shihan Mahmud Redwanul; Hasan, Rajib; Islam, Mohammad Motiul; Gurjar, Mohan; Baronia, Arvind; Kothari, Nikhil; Sharma, Ankur; Karmakar, Saurabh; Sharma, Priya; Nimbolkar, Janardan; Samdani, Pratit; Vaidyanathan, R.; Rubina, Noor Ahmedi; Jain, Nikhilesh; Pahuja, Madhumati; Singh, Ritu; Shekhar, Saurav; Muzaffar, Syed Nabeel; Ozair, Ahmad; Siddiqui, Suhail Sarwar; Bose, Payel; Datta, Avijatri; Rathod, Darshana; Patel, Mayur; Renuka, M. K.; Baby, Sailaja K.; Dsilva, Carol; Chandran, Jagadish; Ghosh, Pralay; Mukherjee, Sudipta; Sheshala, Kaladhar; Misra, Krushna Chandra; Yakubu, Saidu Yusuf; Ugwu, Euphemia Mgbosoro; Olatosi, John O.; Desalu, Ibironke; Asiyanbi, Gabriel; Oladimeji, Motunrayo; Idowu, Olusola; Adeola, Fowotade; Mc Cree, Melanie; Karar, Ali Adil Ali; Saidahmed, Elfayadh; Hamid, Hytham K. S.; Montrucchio, Giorgia
File in questo prodotto:
File Dimensione Formato  
Tabah_Intensive Care Med_2023.pdf

Accesso riservato

Descrizione: PDF
Tipo di file: PDF EDITORIALE
Dimensione 1.23 MB
Formato Adobe PDF
1.23 MB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/1954016
Citazioni
  • ???jsp.display-item.citation.pmc??? 30
  • Scopus 47
  • ???jsp.display-item.citation.isi??? 43
social impact