title: Bloodstream infections and sepsis in Greece: over-time change of epidemiology and impact of de-escalation on final outcome.
abstract: BACKGROUND
  Choice of empirically prescribed antimicrobials for sepsis management depends on epidemiological factors. The epidemiology of sepsis in Greece was studied in two large-periods.
  
  
  METHODS
  Sepsis due to bloodstream infections (BSI) from July 2006 until March 2013 was recorded in a multicenter study in 46 departments. Patients were divided into sepsis admitted in the emergencies and hospitalized in the general ward (GW) and sepsis developing after admission in the Intensive Care Unit (ICU). The primary endpoints were the changes of epidemiology and the factors related with BSIs by multidrug-resistant (MDR) pathogens; the secondary endpoint was the impact of de-escalation on antimicrobial therapy.
  
  
  RESULTS
  754 patients were studied; 378 from 2006-2009 and 376 from 2010-2013. Major differences were recorded between periods in the GW. They involved increase of: sepsis severity; the incidence of underlying diseases; the incidence of polymicrobial infections; the emergence of Klebsiella pneumoniae as a pathogen; and mortality. Factors independently related with BSI by MDR pathogens were chronic hemofiltration, intake of antibiotics the last three months and residence into long-term care facilities. De-escalation in BSIs by fully susceptible Gram-negatives did not affect final outcome. Similar epidemiological differences were not found in the ICU; MDR Gram-negatives predominated in both periods.
  
  
  CONCLUSIONS
  The epidemiology of sepsis in Greece differs in the GW and in the ICU. De-escalation in the GW is a safe strategy.
authors.forename: Marina
authors.initials: M
authors.lastname: Koupetori
authors.forename: Theodoros
authors.initials: T
authors.lastname: Retsas
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Antonakos
authors.forename: Glykeria
authors.initials: G
authors.lastname: Vlachogiannis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Perdios
authors.forename: Christos
authors.initials: C
authors.lastname: Nathanail
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Makaritsis
authors.forename: Antonios
authors.initials: A
authors.lastname: Papadopoulos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Sinapidis
authors.affiliation: 4th Department of Internal Medicine, University of Athens, Medical School, 1 Rimini Street, 12462 Athens, Greece. egiamarel@med.uoa.gr.
authors.forename: Evangelos J
authors.initials: EJ
authors.lastname: Giamarellos-Bourboulis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Pneumatikos
authors.forename: Charalambos
authors.initials: C
authors.lastname: Gogos
authors.forename: Apostolos
authors.initials: A
authors.lastname: Armaganidis
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Paramythiotou
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents