title: Bloodstream infections in ICU with increased resistance: epidemiology and outcomes.
abstract: BACKGROUND
  Aim of this study was to evaluate the epidemiology and outcomes of hospital-acquired bloodstream infections (HA-BSI) in Greek intensive care units (ICU).
  
  
  METHODS
  Secondary analysis of data from 29 ICU collected during the EUROBACT study, a large prospective, observational, multination survey of HA-BSI. First episodes of HA-BSI acquired in the ICU or within 48 hours prior to admission were recorded.
  
  
  RESULTS
  Gram-negative bacteria predominated namely Acinetobacter sp, Klebsiella sp, Pseudomonas sp (73.3% of monomicrobial infections) followed by Gram-positive cocci (18.3%); fungi (7.6%) and anaerobes (0.8%). Overall 73.3% of isolates were multidrug resistant (MDR), 47.1% extensively resistant (XDR) and 1.2% pan-drug resistant (PDR). Carbapenems were the most frequent empirically prescribed antibiotics, while colistin was the most frequently adequate; for both, calculated mean total daily doses were suboptimal. Overall 28-day all-cause mortality was 33.3%. In the multivariate analysis, factors adversely affecting outcome were higher SOFA score at HA-BSI onset (OR 1.19; 95% CI 1.08-1.31, P=0.0006), need for renal supportive therapy (OR 2.75; 95% CI 1.35-5.59, P=0.0053), and for vasopressors/inotropes (OR 2.68; CI 1.18-6.12, P=0.02); adequate empirical treatment had a protective effect (OR 0.48; CI 0.24-0.95, P=0.03).
  
  
  CONCLUSIONS
  TIMELY administration of adequately dosed treatment regimens and early ICU admission of critically ill patients could help in improving outcomes.
authors.affiliation: Critical Care Department, Attikon University Hospital, Medical School, University of Athens, Athens, Greece - gdimop@med.uoa.gr.
authors.forename: G
authors.initials: G
authors.lastname: Dimopoulos
authors.forename: D
authors.initials: D
authors.lastname: Koulenti
authors.forename: A
authors.initials: A
authors.lastname: Tabah
authors.forename: G
authors.initials: G
authors.lastname: Poulakou
authors.forename: A
authors.initials: A
authors.lastname: Vesin
authors.forename: K
authors.initials: K
authors.lastname: Arvaniti
authors.forename: D
authors.initials: D
authors.lastname: Lathyris
authors.forename: D K
authors.initials: DK
authors.lastname: Matthaiou
authors.forename: A
authors.initials: A
authors.lastname: Armaganidis
authors.forename: J F
authors.initials: JF
authors.lastname: Timsit
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D016638:Critical Illness; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology* / Q000628:therapy; D004352:Drug Resistance, Microbial; D005260:Female; D006115:Greece / Q000453:epidemiology; D006402:Hematologic Diseases / Q000453:epidemiology* / Q000382:microbiology* / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents