title: Methicillin-resistant Staphylococcus aureus bloodstream infections are associated with a higher energy deficit than other ICU-acquired bacteremia.
abstract: OBJECTIVE
  Caloric insufficiency during the first week of intensive care unit (ICU) stay was reported to be associated with increased infection rates, especially ICU-acquired bloodstream infection (ICU-BSI). However, the predisposition to ICU-BSI by a given pathogen remains not well known. We aimed to determine the impact of early energy-calorie deficit on the pathogens responsible for ICU-BSI.
  
  
  METHODS
  Prospective, observational, cohort study in a 18-bed medical ICU of a tertiary care hospital.
  
  
  METHODS
  Daily energy balance (energy-calorie intakes minus calculated energy-calorie expenditure) was compared according to the microbiological results of the blood cultures of 92 consecutive prolonged (at least 96 h) acute mechanically ventilated patients who developed a first episode of ICU-BSI.
  
  
  RESULTS
  Among the 92 ICU-BSI, nine were due to methicillin-resistant Staphylococcus aureus (MRSA). The cumulated energy deficit of patients with MRSA ICU-BSI was greater than those with ICU-BSI caused by other pathogens (-1,348 ± 260 vs -1,000 ± 401 kcal/day from ICU admission to day of ICU-BSI, p = 0.008). ICU admission, risk factors for nosocomial infections, nutritional status, and conditions potentially limiting feeding did not differ significantly between the two groups. Patients with MRSA ICU-BSI had lower delivered energy and similar energy expenditure, causing higher energy deficits. More severe energy deficit and higher rate of MRSA blood cultures (p = 0.01 comparing quartiles) were observed.
  
  
  CONCLUSIONS
  Early in-ICU energy deficit was associated with MRSA ICU-BSI in prolonged acute mechanically ventilated patients. Results suggest that limiting the early energy deficit could be a way to optimize MRSA ICU-BSI prevention.
authors.affiliation: Intensive Care Unit, Gustave Roussy, Cancer Campus, Grand Paris, Villejuif, France.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ekpe
authors.forename: Ana
authors.initials: A
authors.lastname: Novara
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Mainardi
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Fagon
authors.forename: Christophe
authors.initials: C
authors.lastname: Faisy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D044342:Malnutrition / Q000453:epidemiology* / Q000517:prevention & control*; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012772:Shock, Septic / Q000453:epidemiology* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology