title: Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study.
abstract: OBJECTIVE
  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.
authors.affiliation: Albert Michallon University Hospital, Université Grenoble 1, Grenoble, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Tabah
authors.forename: Despoina
authors.initials: D
authors.lastname: Koulenti
authors.forename: Kevin
authors.initials: K
authors.lastname: Laupland
authors.forename: Benoit
authors.initials: B
authors.lastname: Misset
authors.forename: Jordi
authors.initials: J
authors.lastname: Valles
authors.forename: Frederico
authors.initials: F
authors.lastname: Bruzzi de Carvalho
authors.forename: José Artur
authors.initials: JA
authors.lastname: Paiva
authors.forename: Nahit
authors.initials: N
authors.lastname: Cakar
authors.forename: Xiaochun
authors.initials: X
authors.lastname: Ma
authors.forename: Philippe
authors.initials: P
authors.lastname: Eggimann
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
authors.forename: Marc J M
authors.initials: MJ
authors.lastname: Bonten
authors.forename: Akos
authors.initials: A
authors.lastname: Csomos
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Krueger
authors.forename: Adam
authors.initials: A
authors.lastname: Mikstacki
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
authors.forename: Pieter
authors.initials: P
authors.lastname: Depuydt
authors.forename: Aurélien
authors.initials: A
authors.lastname: Vesin
authors.forename: Maité
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
authors.forename: Stijn
authors.initials: S
authors.lastname: Blot
authors.forename: Jean
authors.initials: J
authors.lastname: Carlet
authors.forename: Christian
authors.initials: C
authors.lastname: Brun-Buisson
authors.forename: Claude
authors.initials: C
authors.lastname: Martin
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.forename: Georges
authors.initials: G
authors.lastname: Dimopoulos
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D004352:Drug Resistance, Microbial; D005060:Europe / Q000453:epidemiology; D005260:Female; D016469:Fungemia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000890:Anti-Infective Agents