title: Infections, antibiotic treatment and mortality in patients admitted to ICUs in countries considered to have high levels of antibiotic resistance compared to those with low levels.
abstract: BACKGROUND
  Antimicrobial resistance is an increasing concern in ICUs worldwide. Infection with an antibiotic resistant (ABR) strain of an organism is associated with greater mortality than infection with the non-resistant strain, but there are few data assessing whether being admitted to an intensive care unit (ICU) with high levels of antimicrobial resistance is associated with a worse outcome than being admitted to an ICU with low rates of resistance. The aim of this study was, therefore, to compare the characteristics of infections and antibiotic treatments and patient outcomes in patients admitted to ICUs in countries considered as having high levels of antibiotic resistance and those admitted to ICUs in countries considered as having low levels of antibiotic resistance.
  
  
  METHODS
  Data from the large, international EPIC II one-day point prevalence study on infections in patients hospitalized in ICUs were used. For the current study, we compared the data obtained from patients from two groups of countries: countries with reported MRSA rates of ≥ 25% (highABR: Greece, Israel, Italy, Malta, Portugal, Spain, and Turkey) and countries with MRSA rates of < 5% (lowABR: Denmark, Finland, Netherlands, Norway, and Sweden).
  
  
  RESULTS
  On the study day, 1187/2204 (53.9%) patients in the HighABR ICUs were infected and 255/558 (45.7%) in the LowABR ICUs (P < 0.01). Patients in the HighABR ICUs were more severely ill than those in the LowABR ICUs, as reflected by a higher SAPS II score (35.6 vs 32.7, P < 0.05) and had longer median ICU (12 days vs 5 days) and hospital (24 days vs 16 days) lengths of stay. They also had higher crude ICU (20.0% vs 15.4%) and hospital (27.0% vs 21.5%) mortality rates (both P < 0.05). However, after multivariable adjustment and matched pair analysis there were no differences in ICU or hospital mortality rates between High or LowABR ICU patients overall or among those with infections.
  
  
  CONCLUSIONS
  Being hospitalized in an ICU in a region with high levels of antimicrobial resistance is not associated per se with a worse outcome.
authors.forename: Håkan
authors.initials: H
authors.lastname: Hanberger
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
authors.forename: Martin
authors.initials: M
authors.lastname: Holmbom
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
authors.forename: Peter
authors.initials: P
authors.lastname: Pickkers
authors.forename: Marc
authors.initials: M
authors.lastname: Leone
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.forename: Yasser
authors.initials: Y
authors.lastname: Sakr
authors.forename: Sten M
authors.initials: SM
authors.lastname: Walther
authors.forename: Philippe
authors.initials: P
authors.lastname: Vanhems
authors.affiliation: Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. jlvincen@ulb.ac.be.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy* / Q000401:mortality*; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D005060:Europe; D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents