Effect of adequacy of empirical antibiotic therapy for hospital-acquired bloodstream infections on ICU patient prognosis: a causal inference approach using data from the Eurobact2 study.

Loiodice, Ambre; Bailly PharmD, Sébastien; Ruckly, Stéphane; Buetti, Niccolò; Barbier, François; Staiquly, Quentin; Tabah, Alexis; Timsit, Jean-François; EUROBACT-2 Study Group, the European Society of Intensive Care Medicine (ESICM), the European Society of Clinical Microbiology, the Infectious Diseases (ESCMID) Study Group for Infections in Critically Ill Patients (ESGCIP) and the OUTCOMEREA Network

doi:10.1016/j.cmi.2024.09.011

Article (Scientific journals)

Effect of adequacy of empirical antibiotic therapy for hospital-acquired bloodstream infections on ICU patient prognosis: a causal inference approach using data from the Eurobact2 study.

Loiodice, Ambre; Bailly PharmD, Sébastien; Ruckly, Stéphane et al.

2024 • In Clinical Microbiology and Infection

Peer Reviewed verified by ORBi

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https://hdl.handle.net/2268/323503

DOI
10.1016/j.cmi.2024.09.011

PubMed
39326671

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Keywords :

Critically ill; Directed acyclic graph; Hospital-acquired bloodstream infection; Mediation analysis; Sepsis; Time-to-antibiotic therapy; adequacy

Abstract :

[en] [en] OBJECTIVES: Hospital-acquired bloodstream infections (HA-BSI) in the intensive care unit (ICU) are common life-threatening events. We wanted to investigate the association between early adequate antibiotic therapy and 28-day mortality in ICU patients surviving for at least 1 day after the onset of HA-BSI. METHODS: We used individual data from a prospective, observational, multicenter, intercontinental cohort study (Eurobact2). We included patients followed for ≥1 day for whom time-to-appropriate treatment was available. We used an adjusted frailty-Cox proportional hazard model to assess the effect of time-to-treatment-adequacy on 28-day mortality. Infection- and patient-related variables identified as confounders by the Directed Acyclic Graph were used for adjustment. Adequate therapy within 24 hours was used for primary analysis. Secondary analyses were performed for adequate therapy within 48 and 72 hours and for identified patient subgroups. RESULTS: Among the 2,418 patients included in 330 centers worldwide, 28-day mortality was 32.8% (n=402/1226) in patients who were adequately treated within 24 hours after HA-BSI onset and 40% (n=477/1192) in inadequately treated patients (p<0.01). Adequacy within 24 hours was more common in young, immunosuppressed patients, and with HA-BSI due to Gram-negative pathogens. Antimicrobial adequacy was significantly associated with 28-day survival (aHR 0.83, 95% CI 0.72-0.96, p=0.01). The estimated population attributable fraction (PAF) of 28-day mortality of inadequate therapy was 9.15% (95% CI 1.9%-16.2%). CONCLUSIONS: In patients with HA-BSI admitted in ICU, the PAF of 28-day mortality of inadequate therapy within 24 hours was 9.15%. This estimate should be used when hypothesizing the possible benefit of any intervention aiming at reducing the time-to-appropriate antimicrobial therapy in HA-BSI.

Disciplines :

Anesthesia & intensive care

Author, co-author :

Loiodice, Ambre; OUTCOMEREA Research Group, Drancy, France, ICURESEARCH, 26 rue Garibaldi, Fontaine, France

Bailly PharmD, Sébastien; Grenoble Alpes University, INSERM 1300, HP2 Grenoble, France

Ruckly, Stéphane; OUTCOMEREA Research Group, Drancy, France, INSERM, IAME, U1137, Team DeSCID, Paris, France, ICURESEARCH, 26 rue Garibaldi, Fontaine, France

Buetti, Niccolò; INSERM, IAME, U1137, Team DeSCID, Paris, France, Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Service PCI, Geneva, Switzerland

Barbier, François; Centre Hospitalier Régional d'Orléans, Tours, France

Staiquly, Quentin; ICURESEARCH, 26 rue Garibaldi, Fontaine, France

Tabah, Alexis; Queensland University of Technology (QUT), Brisbane, Queensland, Australia, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia, Intensive Care Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia

Timsit, Jean-François; OUTCOMEREA Research Group, Drancy, France, INSERM, IAME, U1137, Team DeSCID, Paris, France, APHP, Bichat hospital, Medical and infectious diseases ICU, F75018, Paris France. Electronic address: Jean-francois.timsit@aphp.fr

EUROBACT-2 Study Group, the European Society of Intensive Care Medicine (ESICM), the European Society of Clinical Microbiology, the Infectious Diseases (ESCMID) Study Group for Infections in Critically Ill Patients (ESGCIP) and the OUTCOMEREA Network

Other collaborator :

LAYIOS, Nathalie ; Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs

Language :

English

Title :

Effect of adequacy of empirical antibiotic therapy for hospital-acquired bloodstream infections on ICU patient prognosis: a causal inference approach using data from the Eurobact2 study.

Publication date :

24 September 2024

Journal title :

Clinical Microbiology and Infection

ISSN :

1198-743X

eISSN :

1469-0691

Publisher :

Elsevier BV, England

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://api.elsevier.com/content/article/PII:S1198743X24004439?httpAccept=text/xml

Funders :

Fondation Université Grenoble Alpes
SNF - Schweizerischer Nationalfonds zur Förderung der wissenschaftlichen Forschung
ANR - Agence Nationale de la Recherche

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