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

Alexis Tabah; Niccolo Buetti; Quentin Staiquly; Stephane Ruckly; Murat Akova; Abdullah Tarik Aslan; Marc Leone; Andrew Conway Morris; Matteo Bassetti; Kostoula Arvaniti; Jeffrey Lipman; Ricard Ferrer; Haibo Qiu; Jose-Artur Paiva; Pedro Povoa; Liesbet De Bus; Jan De Waele; Farid Zand; Mohan Gurjar; Khalid Abidi; Adel Alsisi; Hendrik Bracht; Yoshiro Hayashi; Kyeongman Jeon; Muhammed Elhadi; Francois Barbier; Jean-Francois Timsit; Olusola A Idowu; EUROBACT-2 Study Group; European Society of Intensive  Care Medicine (ESICM); ESCMID Study Group for Infections in Critically Ill Patients (ESGCIP); OUTCOMEREA Network

doi:10.1007/s00134-022-06944-2

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

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

Alexis Tabah, Niccolo Buetti, Quentin Staiquly, Stephane Ruckly, Murat Akova, Abdullah Tarik Aslan, Marc Leone, Andrew Conway Morris, Matteo Bassetti, Kostoula Arvaniti, …

Intensive care medicine, Vol.49(2), pp.178-190

02/01/2023

DOI: 10.1007/s00134-022-06944-2

PMCID: PMC9916499

PMID: 36764959

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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.

Critical Care Medicine

General & Internal Medicine

Life Sciences & Biomedicine

Science & Technology

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Title: Subtitle: Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study
Creators: Alexis Tabah - Redcliffe Hospital
Niccolo Buetti - Université Paris Cité
Quentin Staiquly
Stephane Ruckly - Université Paris Cité
Murat Akova - Hacettepe University
Abdullah Tarik Aslan - Hacettepe University
Marc Leone - Aix-Marseille Université
Andrew Conway Morris - Addenbrooke's Hospital
Matteo Bassetti - University of Genoa
Kostoula Arvaniti - Papageorgiou General Hospital
Jeffrey Lipman - Royal Brisbane and Women's Hospital
Ricard Ferrer - Vall d'Hebron Institut de Recerca
Haibo Qiu - Zhongda Hospital Southeast University
Jose-Artur Paiva - Universidade do Porto
Pedro Povoa - Universidade Nova de Lisboa
Liesbet De Bus - Ghent University Hospital
Jan De Waele - Ghent University Hospital
Farid Zand - Shiraz University of Medical Sciences
Mohan Gurjar - Sanjay Gandhi Post Graduate Institute of Medical Sciences
Khalid Abidi - Mohammed V University
Adel Alsisi - Cairo University
Hendrik Bracht - University Hospital Ulm
Yoshiro Hayashi - Kameda Medical Center
Kyeongman Jeon - Samsung Medical Center
Muhammed Elhadi - University of Tripoli
Francois Barbier - Centre hospitalier universitaire d'Orléans
Jean-Francois Timsit - Univ Paris Cite, INSERM, IAME UMR 1137, F-75018 Paris, France
Olusola A Idowu (Contributor)
EUROBACT-2 Study Group
European Society of Intensive Care Medicine (ESICM)
ESCMID Study Group for Infections in Critically Ill Patients (ESGCIP)
OUTCOMEREA Network
Resource Type: Journal article
Publication Details: Intensive care medicine, Vol.49(2), pp.178-190
DOI: 10.1007/s00134-022-06944-2
PMID: 36764959
PMCID: PMC9916499
NLM abbreviation: Intensive Care Med
ISSN: 0342-4642
eISSN: 1432-1238
Publisher: Springer Nature
Number of pages: 13
Grant note: 1881020N / Research Foundation Flanders (FWO); FWO MR/V006118/1 / Medical Research Council Clinician Scientist Fellowship; UK Research & Innovation (UKRI); Medical Research Council UK (MRC) P4P4PM_194449 / Swiss National Science Foundation; Swiss National Science Foundation (SNSF)
Language: English
Date published: 02/01/2023
Academic Unit: Anesthesia
Record Identifier: 9984787460202771

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