title: Microbiologic characteristics and predictors of mortality in bloodstream infections in intensive care unit patients: A 1-year, large, prospective surveillance study in 5 Italian hospitals.
abstract: BACKGROUND
  Bloodstream infections (BSIs) from multidrug-resistant (MDR) bacteria cause morbidity and mortality in intensive care unit (ICU) patients worldwide. This study investigated the incidence of BSIs in 5 adult general ICUs in Rome, Italy, and evaluated the mortality rate and risk factors associated with these infections.
  
  
  METHODS
  Over a 12-month period, 1,318 patients were enrolled. Demographic characteristics, Simplified Acute Physiology Score II (SAPS II), comorbidities, and BSI isolate data were collected. After stratification for the outcome, statistical analysis was performed to assess the impact of patient risk factors on in-hospital mortality.
  
  
  RESULTS
  There were 324 BSIs in 175 patients recorded, with an in-hospital mortality rate of 46%. Univariate analysis revealed that SAPS II, cardiac comorbidity, and Klebsiella pneumoniae BSI were significantly associated with a higher risk of death. Having a K pneumoniae BSI and cardiac illness at admission were both confirmed to be associated with death by multivariate analysis (P = .0162 and P = .0158, respectively). Most of the K pneumoniae isolates showed high resistance rates to carbapenems.
  
  
  CONCLUSIONS
  BSIs caused by K pneumoniae and cardiovascular comorbidity in ICU patients are associated with a higher risk of death. Thorough surveillance for MDR pathogens and stratification of the patients' risk on admission into the ICU are key to improving the outcomes of these infections.
authors.affiliation: Clinical Infectious Diseases, Tor Vergata Hospital, Rome, Italy. Electronic address: diego.dellerose82@gmail.com.
authors.forename: Diego
authors.initials: D
authors.lastname: Delle Rose
authors.affiliation: Clinical Infectious Diseases, Tor Vergata Hospital, Rome, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Sordillo
authors.affiliation: Clinical Infectious Diseases, Tor Vergata Hospital, Rome, Italy.
authors.forename: Sabina
authors.initials: S
authors.lastname: Gini
authors.affiliation: Clinical Infectious Diseases, Tor Vergata Hospital, Rome, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Cerva
authors.affiliation: Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Boros
authors.affiliation: Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rezza
authors.affiliation: S. Filippo Neri Hospital, Rome, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Meledandri
authors.affiliation: San Gallicano Dermatologic Institute, IRCCS, Istituti Fisioterapici Ospitalieri, Rome, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Gallo
authors.affiliation: San Gallicano Dermatologic Institute, IRCCS, Istituti Fisioterapici Ospitalieri, Rome, Italy.
authors.forename: Grazia
authors.initials: G
authors.lastname: Prignano
authors.affiliation: Intensive Care Unit, S. Giovanni Hospital, Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Caccese
authors.affiliation: Intensive Care Unit, S. Giovanni Hospital, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: D'Ambrosio
authors.affiliation: Intensive Care Unit, La Sapienza University, Rome, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Citterio
authors.affiliation: Intensive Care Unit, La Sapienza University, Rome, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Rocco
authors.affiliation: Intensive Care Unit, Tor Vergata Hospital, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Leonardis
authors.affiliation: Intensive Care Unit, Tor Vergata Hospital, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Natoli
authors.affiliation: Clinical Microbiology Laboratories, Tor Vergata Hospital, Rome, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Fontana
authors.affiliation: Clinical Microbiology Laboratories, Tor Vergata Hospital, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Favaro
authors.affiliation: Clinical Pharmacy, Tor Vergata University, Rome, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Celeste
authors.affiliation: S. Andrea Hospital, Rome, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Franci
authors.affiliation: Clinical Infectious Diseases, Tor Vergata Hospital, Rome, Italy.
authors.forename: Gian Piero
authors.initials: GP
authors.lastname: Testore
authors.affiliation: Clinical Infectious Diseases, Tor Vergata Hospital, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Andreoni
authors.affiliation: Clinical Infectious Diseases, Tor Vergata Hospital, Rome, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Sarmati
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000453:epidemiology / Q000401:mortality*; D062665:Epidemiological Monitoring; D005260:Female; D006761:Hospitals; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012384:Rome / Q000453:epidemiology
keywords: Bloodstream infections; Intensive care unit; Klebsiella pneumoniae; Microbiology; Mortality; Predictors