antibiotic resistance; bacteremia; bloodstream infection; hospital-acquired; Anti-Infective Agents; Carbapenems; Anti-Bacterial Agents; Adult; Humans; Cohort Studies; Prospective Studies; Intensive Care Units; Escherichia coli; Hospitals; Carbapenems/therapeutic use; Anti-Bacterial Agents/therapeutic use; Bacteremia/drug therapy; Cross Infection/prevention & control; Anti-Infective Agents/therapeutic use; Cross Infection; Critical Care and Intensive Care Medicine
Abstract :
[en] [en] 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.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Tabah, Alexis ; Intensive Care Unit, Redcliffe Hospital, Brisbane, Australia. a.tabah@uq.edu.au ; Queensland Critical Care Research Network (QCCRN), Brisbane, QLD, Australia. a.tabah@uq.edu.au ; Queensland University of Technology, Brisbane, QLD, Australia. a.tabah@uq.edu.au ; Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia. a.tabah@uq.edu.au
Buetti, Niccolò; Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland ; Université de Paris, INSERM, IAME UMR 1137, 75018, Paris, France
Staiquly, Quentin; ICUREsearch, Biometry, 38600, Fontaine, France
Ruckly, Stéphane; Université de Paris, INSERM, IAME UMR 1137, 75018, Paris, France ; ICUREsearch, Biometry, 38600, Fontaine, France
Akova, Murat; Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
Aslan, Abdullah Tarik; Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
Leone, Marc; Department of Anesthesiology and Intensive Care Unit, Hospital Nord, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France
Conway Morris, Andrew ; Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK ; Division of Immunology, Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, Cb2 1QP, UK ; JVF Intensive Care Unit, Addenbrooke's Hospital, Cambridge, Hills Road, Cambridge, CB2 0QQ, UK
Bassetti, Matteo; Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
Arvaniti, Kostoula; Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
Lipman, Jeffrey; Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia ; Nimes University Hospital, University of Montpellier, Nimes, France ; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, Australia
Ferrer, Ricard; Intensive Care Department, SODIR-VHIR Research Group, Vall d'Hebron University Hospital, Barcelona, Spain
Qiu, Haibo; Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Nanjing Zhongda Hospital, Southeast University, Nanjing, 210009, China
Paiva, José-Artur; Intensive Care Medicine Department, Centro Hospitalar Universitário Sao Joao, Porto, Portugal ; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal ; Infection and Sepsis ID Group, Porto, Portugal
Povoa, Pedro; NOVA Medical School, New University of Lisbon, Lisbon, Portugal ; Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark ; Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
De Bus, Liesbet ; Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
De Waele, Jan ; Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium ; Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
Zand, Farid; Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Gurjar, Mohan ; Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
Alsisi, Adel; ICU Department, Prime Hospital, Dubai, United Arab Emirates ; Critical Care Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Abidi, Khalid; Medical ICU, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
Bracht, Hendrik; Central Interdisciplinary Emergency Medicine, University Hospital Ulm, Ulm, Germany
Hayashi, Yoshiro; Department of Intensive Care Medicine, Kameda General Hospital, Kamogawa, Japan
Jeon, Kyeongman; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
Elhadi, Muhammed; Faculty of Medicine, University of Tripoli, Tripoli, Libya
Barbier, François; Service de Médecine Intensive-Réanimation, Centre Hospitalier Régional d'Orléans, 14, avenue de L'Hôpital, 45100, Orléans, France
Timsit, Jean-François; Université Paris-Cité, INSERM, IAME UMR 1137, 75018, Paris, France ; Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 Omdurman maternity hospitalrue Henri Huchard, 75877, Paris Cedex, France
ESICM - European Society of Intensive Care Medicine [BE] ESCMID - European Society of Clinical Microbiology and Infectious Diseases [CH] Norva Dahlia Intensive Care Research Foundation [AU] Redcliffe Hospital [AU]
Funding text :
JdW is a senior clinical investigator funded by the Research Foundation Flanders (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 Foundation. 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 Redcliffe Hospital Private Practice Trust Fund.The EUROBACT-2 study was endorsed by the European Society of Intensive Care Medicine (ESICM), the infection section of the ESCIM and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) study Group for Infections in Critically Ill Patients (ESGCIP), with scientific input of the OUTCOMEREA network. The members of the Eurobact 2 Study Group are: Alexis Tabah, Hamish Pollock, Ben Margetts, Meredith Young, Neeraj Bhadange, Steven Tyler, Anne Ledtischke, Mackenzie Finnis, Anne Ledtischke, Mackenzie Finnis, Jyotsna Dwivedi, Manoj Saxena, Vishwanath Biradar, Natalie Soar, Vineet Sarode, David Brewster, Adrian Regli, Elizabeth Weeda, Samiul Ahmed, Cheryl Fourie, Kevin Laupland, Mahesh Ramanan, James Walsham, Jason Meyer, Edward Litton, Anna Maria Palermo, Timothy Yap, Ege Eroglu, Antony George Attokaran, C'havala Jaramillo, Khalid Mahmood Khan Nafees, Nurhikmahtul Aqilah Haji Abd Rashid, Haji Adi Muhamad Ibnu Walid, Tomas Mon, P. Dhakshina Moorthi, Shah Sudhirchandra, Dhadappa Damodar Sridharan, Qiu Haibo, Xie Jianfeng, Lu Wei-Hua, Wang Zhen, Chuanyun Qian, Jili Luo, Xiaomei Chen, Hao Wang, Peng Zhao, Juan Zhao, Qiu Wusi, Chen Mingmin, Lei Xu, Chengfen Yin, Ruilan Wang, Jinfeng Wang, Yongjie Yin, Min Zhang, Jilu Ye, Chungfang Hu, Suming Zhou, Min Huang, Jing Yan, Yan Wang, Bingyu Qin, Ling Ye, Xie Weifeng, Li Peije, Nan Geng, Yoshiro Hayashi, Toshiyuki Karumai, Masaki Yamasaki, Satoru Hashimoto, Koji Hosokawa, Jun Makino, Takeo Matsuyoshi, Akira Kuriyama, Hidenobu Shigemitsu, Yuka Mishima, Michio Nagashima, Hideki Yoshida, Shigeki Fujitani, Koichiro Omori, Hiroshi Rinka, Hiroki Saito, Kaori Atobe, Hideaki Kato, Shunsuke Takaki, M. Shahnaz Hasan, Muhamad Fadhil Hadi Jamaluddin, Lee See Pheng, Sheshendrasurian Visvalingam, Mun Thing Liew, Siong Ling Danny Wong, Kean Khang Fong, Hamizah Bt Abdul Rahman, Zuraini Md Noor, Lee Kok Tong, Abd. Hamid Azman, Mohd Zulfakar Mazlan, Saedah Ali, Kyeongman Jeon, Sang-Min Lee, Sunghoon Park, Seung Yong Park, Sung Yoon Lim, Qing Yuan Goh, Shin Yi Ng, Sui An Lie, Andrea Lay Hoon Kwa, Ken Junyang Goh, Andrew Yunkai Li, Caroline Yu Ming Ong, Jia Yan Lim, Jessica Lishan Quah, Kangqi Ng, Louis Xiang Long Ng, Yu Chang Yeh, Nai-Kuan Chou, Cong-Tat Cia, Ting-Yu Hu, Li-Kuo Kuo, Shih-Chi Ku, Phunsup Wongsurakiat, Yutthana Apichatbutr, Supattra Chiewroongroj, Rashid Nadeem, Ashraf El Houfi, Adel Alsisi, Amr Elhadidy, Mina Barsoum, Nermin Osman, Tarek Mostafa, Mohamed Elbahnasawy, Ahmed Saber, Amer Aldhalia, Omar Elmandouh, Ahmed Elsayed, Merihan A. Elbadawy, Ahmed K. Awad, Hanan M. Hemead, Farid Zand, Maryam Ouhadian, Seyed Hamid Borsi, Zahra Mehraban, Davood Kashipazha, Fatemeh Ahmadi, Mohsen Savaie, Farhad Soltani, Mahboobeh Rashidi, Reza Baghbanian, Fatemeh Javaherforoosh, Fereshteh Amiri, Arash Kiani, Mohammad Amin Zargar, Ata Mahmoodpoor, Fatemeh Aalinezhad, Gholamreza Dabiri, Golnar Sabetian, Hakimeh Sarshad, Mansoor Masjedi, Ramin Tajvidi, Seyed Mohammad Nasirodin Tabatabaei, Abdullah Khudhur Ahmed, Pierre Singer, Ilya Kagan, Merav Rigler, Daniel Belman, Phillip Levin, Belal Harara, Adei Diab, Fayez Abilama, Rebecca Ibrahim, Aya Fares, Ahmad Buimsaedah, Marwa Gamra, Ahmed Aqeelah, Almajdoub Ali Mohammed Ali, Ahmed Gaber Sadik Homaidan, Bushray Almiqlash, Hala Bilkhayr, Ahmad Bouhuwaish, Ahmed Sa Taher, Eman Abdulwahed, Fathi A
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