title: Evaluating the management of 493 patients presenting with bacteremia in 23 northern French hospitals.
abstract: OBJECTIVE
  We aimed to update the epidemiology of bacteremia and evaluate their management and short-term outcome.
  
  
  METHODS
  We conducted a prospective multicenter survey from October to November 2011. Consecutive patients with at least one positive blood culture (BC) were included in the study. We evaluated the type and adequacy of empirical and documented antibiotic therapy, time to active antibiotic therapy, compliance with guidelines, and 10-day outcome.
  
  
  RESULTS
  A total of 23 public and private hospitals and 633 patients (493 true pathogens and 140 contaminants) were included in the study. Patients' wards were medicine (57%), surgery (19%), intensive care (14%), onco/hematology (3.7%), pediatrics (3.4%), infectious diseases (1.8%), and obstetrics (1.2%). Main pathogens were Escherichia coli (36%), Staphylococcus aureus (16%), coagulase-negative staphylococci, and Klebsiella sp. (8% each). A total of 43 (8.7%) multidrug-resistant strains were observed, including 26 extended-spectrum beta-lactamase strains and 15 methicillin-resistant S. aureus strains. An antibiotic active against the isolated pathogen was used in 74% of empirical and 96% of documented therapies. Median time between BC and administration of an active drug was 0.61 day. Empirical antibiotic therapies were protocol-compliant in 77% of cases. Few (4%) patients with contaminated BC received an antibiotic therapy (all inappropriate). Day-10 mortality was 12.1%, higher in patients presenting with severe sepsis or septic shock (22.5%) than in patients presenting with non-severe bacteremia (7.1%; P<0.0001).
  
  
  CONCLUSIONS
  The management of bacteremia seems satisfactory in these volunteer hospitals but bacteremia remains a severe infection.
authors.affiliation: Service de réanimation et maladies infectieuses, centre hospitalier Dron, 155, rue du Président-Coty, 59200 Tourcoing, France. Electronic address: alfandari.s@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Alfandari
authors.affiliation: Réanimation polyvalente, centre hospitalier Saint-Philibert, rue du Grand-But, 59160 Lomme, France.
authors.forename: P
authors.initials: P
authors.lastname: Cabaret
authors.affiliation: Infectiologie, centre hospitalier, 62408 Béthune cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Nguyen
authors.affiliation: Laboratoire de microbiologie, centre hospitalier, 62408 Béthune cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Descamps
authors.affiliation: Laboratoire de microbiologie, centre hospitalier, 59100 Roubaix, France.
authors.forename: A
authors.initials: A
authors.lastname: Vachée
authors.affiliation: Laboratoire de microbiologie, centre hospitalier, 59300 Valenciennes, France.
authors.forename: C
authors.initials: C
authors.lastname: Cattoen
authors.affiliation: Maladies infectieuses, centre hospitalier, 99, route de la Bassée, 862307 Lens cedex, France.
authors.forename: N
authors.initials: N
authors.lastname: Van Grunderbeeck
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D019468:Disease Management; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence; D006748:Hospital Departments; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000401:mortality; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Antibiotiques; Antimicrobial stewardship; Bacteremia; Bactériémie; Bon usage