Special Article

Intensive Care Medicine

, Volume 38, Issue 12, pp 1930-1945

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

  • Alexis TabahAffiliated withMedical ICU, Albert Michallon University Hospital, Université Grenoble 1Albert Bonniot Institute, Team 11: Outcome of Mechanically Ventilated Patients and Respiratory Cancers, Université Grenoble 1, U 823Outcomerea Organization
  • , Despoina KoulentiAffiliated withDepartment of Critical Care, University Hospital ATTIKON, Medical School University of Athens
  • , Kevin LauplandAffiliated withAlbert Bonniot Institute, Team 11: Outcome of Mechanically Ventilated Patients and Respiratory Cancers, Université Grenoble 1, U 823Peter Lougheed Centre, Department of Critical Care Medicine, University of Calgary and Alberta Health Services
  • , Benoit MissetAffiliated withParis Sorbonne Cité, Medical Surgical ICU, Groupe Hospitalier Paris Saint-Joseph, Université Paris Descartes
  • , Jordi VallesAffiliated withCritical Care Center, Hospital Sabadell
  • , Frederico Bruzzi de CarvalhoAffiliated withCentro De Terapia Intensiva, Hospital Mater Dei
  • , José Artur PaivaAffiliated withEmergency and Intensive Care Unit, Hospital de S. Joao
  • , Nahit ÇakarAffiliated withMedical ICU, Albert Michallon University Hospital, Université Grenoble 1Department of Anaesthesiology and Intensive Care, Istanbul University and Istanbul Medical School
  • , Xiaochun MaAffiliated withMedical ICU, Albert Michallon University Hospital, Université Grenoble 1Department of Critical Care Medicine, The First Affiliated Hospital of China Medical University
    • , Philippe EggimannAffiliated withMedical ICU, Albert Michallon University Hospital, Université Grenoble 1Adult Critical Care Medicine and Burn Centre, Centre Hospitalier Universitaire Vaudois
    • , Massimo AntonelliAffiliated withMedical ICU, Albert Michallon University Hospital, Université Grenoble 1Department of Intensive Care and Anaesthesiology, Policlinico Universitario A
    • , Marc J. M. BontenAffiliated withMedical ICU, Albert Michallon University Hospital, Université Grenoble 1Department of Medical Microbiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht
    • , Akos CsomosAffiliated withMedical ICU, Albert Michallon University Hospital, Université Grenoble 1Surgical Intensive Care, Semmelweis University
    • , Wolfgang A. KruegerAffiliated withMedical ICU, Albert Michallon University Hospital, Université Grenoble 1Anaesthesiology and Intensive Care Medicine, Clinics of Constance
    • , Adam MikstackiAffiliated withMedical ICU, Albert Michallon University Hospital, Université Grenoble 1Department of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences Regional Hospital
    • , Jeffrey LipmanAffiliated withMedical ICU, Albert Michallon University Hospital, Université Grenoble 1Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital
    • , Pieter DepuydtAffiliated withMedical ICU, Albert Michallon University Hospital, Université Grenoble 1Department of Intensive Care, Ghent University Hospital
    • , Aurélien VesinAffiliated withAlbert Bonniot Institute, Team 11: Outcome of Mechanically Ventilated Patients and Respiratory Cancers, Université Grenoble 1, U 823Outcomerea Organization
    • , Maité Garrouste-OrgeasAffiliated withAlbert Bonniot Institute, Team 11: Outcome of Mechanically Ventilated Patients and Respiratory Cancers, Université Grenoble 1, U 823Outcomerea OrganizationParis Sorbonne Cité, Medical Surgical ICU, Groupe Hospitalier Paris Saint-Joseph, Université Paris Descartes
    • , Jean-Ralph ZaharAffiliated withAlbert Bonniot Institute, Team 11: Outcome of Mechanically Ventilated Patients and Respiratory Cancers, Université Grenoble 1, U 823Outcomerea OrganizationInfection Control Unit, Necker University Hospital
    • , Stijn BlotAffiliated withAlbert Bonniot Institute, Team 11: Outcome of Mechanically Ventilated Patients and Respiratory Cancers, Université Grenoble 1, U 823General Internal Medicine and Infectious Diseases, Ghent University Hospital
    • , Jean CarletAffiliated withAlbert Bonniot Institute, Team 11: Outcome of Mechanically Ventilated Patients and Respiratory Cancers, Université Grenoble 1, U 823Consultant for WHO
    • , Christian Brun-BuissonAffiliated withAlbert Bonniot Institute, Team 11: Outcome of Mechanically Ventilated Patients and Respiratory Cancers, Université Grenoble 1, U 823Medical Intensive Care Unit, Henri Mondor Teaching Hospital
    • , Claude MartinAffiliated withAlbert Bonniot Institute, Team 11: Outcome of Mechanically Ventilated Patients and Respiratory Cancers, Université Grenoble 1, U 823Department of Anesthesia and Intensive Care and Trauma Center, Marseilles University Hospital
    • , Jordi RelloAffiliated withAlbert Bonniot Institute, Team 11: Outcome of Mechanically Ventilated Patients and Respiratory Cancers, Université Grenoble 1, U 823Critical Care Department, Vall d’Hebron University Hospital
    • , Georges DimopoulosAffiliated withDepartment of Critical Care, University Hospital ATTIKON, Medical School University of Athens
    • , Jean-François TimsitAffiliated withMedical ICU, Albert Michallon University Hospital, Université Grenoble 1Albert Bonniot Institute, Team 11: Outcome of Mechanically Ventilated Patients and Respiratory Cancers, Université Grenoble 1, U 823Outcomerea Organization Email author 

Abstract

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.

Keywords

Hospital acquired bloodstream infections Critically ill patients Antibiotic therapy Prognosis Multilevel models Extensively resistant bacterias