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The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections.
Buetti, Niccolò; Tabah, Alexis; Setti, Nour; Ruckly, Stéphane; Barbier, François; Akova, Murat; Aslan, Abdullah Tarik; Leone, Marc; Bassetti, Matteo; Morris, Andrew Conway; Arvaniti, Kostoula; Paiva, José-Artur; Ferrer, Ricard; Qiu, Haibo; Montrucchio, Giorgia; Cortegiani, Andrea; Kayaaslan, Bircan; De Bus, Liesbet; De Waele, Jan J; Timsit, Jean-François.
Afiliación
  • Buetti N; Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Centre, Geneva, Switzerland. niccolo.buetti@gmail.com.
  • Tabah A; IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France. niccolo.buetti@gmail.com.
  • Setti N; Intensive Care Unit, Redcliffe Hospital, Brisbane, Australia.
  • Ruckly S; Queensland Critical Care Research Network (QCCRN), Brisbane, QLD, Australia.
  • Barbier F; Queensland University of Technology, Brisbane, QLD, Australia.
  • Akova M; Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
  • Aslan AT; IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France.
  • Leone M; IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France.
  • Bassetti M; Biostatistic Department, Outcomerea, 93700, Drancy, France.
  • Morris AC; Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, 14, Avenue de L'Hôpital, 45000, Orléans, France.
  • Arvaniti K; Institut Maurice Rapin, Hôpital Henri Mondor, Créteil, France.
  • Paiva JA; Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey.
  • Ferrer R; Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
  • Qiu H; Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia.
  • Montrucchio G; Department of Anesthesiology and Intensive Care Unit, Hospital Nord, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France.
  • Cortegiani A; Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy.
  • Kayaaslan B; Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
  • De Bus L; Division of Immunology, Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, Cb2 1QP, UK.
  • De Waele JJ; JVF Intensive Care Unit, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
  • Timsit JF; Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece.
Intensive Care Med ; 50(6): 873-889, 2024 Jun.
Article en En | MEDLINE | ID: mdl-38498170
ABSTRACT

PURPOSE:

The primary objective of this study was to evaluate the associations between centre/country-based factors and two important process and outcome indicators in patients with hospital-acquired bloodstream infections (HABSI).

METHODS:

We used data on HABSI from the prospective EUROBACT-2 study to evaluate the associations between centre/country factors on a process or an outcome indicator adequacy of antimicrobial therapy within the first 24 h or 28-day mortality, respectively. Mixed logistical models with clustering by centre identified factors associated with both indicators.

RESULTS:

Two thousand two hundred nine patients from two hundred one intensive care units (ICUs) were included in forty-seven countries. Overall, 51% (n = 1128) of patients received an adequate antimicrobial therapy and the 28-day mortality was 38% (n = 839). The availability of therapeutic drug monitoring (TDM) for aminoglycosides everyday [odds ratio (OR) 1.48, 95% confidence interval (CI) 1.03-2.14] or within a few hours (OR 1.79, 95% CI 1.34-2.38), surveillance cultures for multidrug-resistant organism carriage performed weekly (OR 1.45, 95% CI 1.09-1.93), and increasing Human Development Index (HDI) values were associated with adequate antimicrobial therapy. The presence of intermediate care beds (OR 0.63, 95% CI 0.47-0.84), TDM for aminoglycoside available everyday (OR 0.66, 95% CI 0.44-1.00) or within a few hours (OR 0.51, 95% CI 0.37-0.70), 24/7 consultation of clinical pharmacists (OR 0.67, 95% CI 0.47-0.95), percentage of vancomycin-resistant enterococci (VRE) between 10% and 25% in the ICU (OR 1.67, 95% CI 1.00-2.80), and decreasing HDI values were associated with 28-day mortality.

CONCLUSION:

Centre/country factors should be targeted for future interventions to improve management strategies and outcome of HABSI in ICU patients.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infección Hospitalaria / Enfermedad Crítica / Unidades de Cuidados Intensivos Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Intensive Care Med Año: 2024 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infección Hospitalaria / Enfermedad Crítica / Unidades de Cuidados Intensivos Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Intensive Care Med Año: 2024 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Estados Unidos