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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2015 April;81(4):405-18
Bloodstream infections in ICU with increased resistance: epidemiology and outcomes
Dimopoulos G. 1, Koulenti D. 1, 2, Tabah A. 2-4, Poulakou G. 5, Vesin A. 6, 7, Arvaniti K. 8, Lathyris D. 9, Matthaiou D. K. 1, Armaganidis A. 1, Timsit J. F. 4, 6, 7 ✉
1 Critical Care Department, Attikon University Hospital, Medical School, University of Athens, Athens, Greece;
2 Burns, Trauma, and Critical Care Research Centre, University of Queensland, Brisbane, Australia;
3 Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Australia;
4 Medical ICU, Albert Michallon University Hospital, Grenoble, France;
5 Fourth Department of Internal Medicine, Attikon University Hospital, Medical School, University of Athens, Athens, Greece;
6 Université Grenoble 1, U 823, Albert Bonniot Institute; Team 11: Outcome of mechanically ventilated patients and respiratory cancers, Grenoble, France;
7 Outcomerea Organization, Paris, France;
8 Critical Care Department, General Hospital “Papageorghiou”, Thessaloniki, Greece;
9 Critical Care Department, General Hospital “G. Gennimatas”, Thessaloniki, Greece
BACKGROUND: Aim of this study was to evaluate the epidemiology and outcomes of hospital-acquired bloodstream infections (HA-BSI) in Greek intensive care units (ICU).
METHODS: Secondary analysis of data from 29 ICU collected during the EUROBACT study, a large prospective, observational, multination survey of HA-BSI. First episodes of HA-BSI acquired in the ICU or within 48 hours prior to admission were recorded.
RESULTS: Gram-negative bacteria predominated namely Acinetobacter sp, Klebsiella sp, Pseudomonas sp (73.3% of monomicrobial infections) followed by Gram-positive cocci (18.3%); fungi (7.6%) and anaerobes (0.8%). Overall 73.3% of isolates were multidrug resistant (MDR), 47.1% extensively resistant (XDR) and 1.2% pan-drug resistant (PDR). Carbapenems were the most frequent empirically prescribed antibiotics, while colistin was the most frequently adequate; for both, calculated mean total daily doses were suboptimal. Overall 28-day all-cause mortality was 33.3%. In the multivariate analysis, factors adversely affecting outcome were higher SOFA score at HA-BSI onset (OR 1.19; 95% CI 1.08-1.31, P=0.0006), need for renal supportive therapy (OR 2.75; 95% CI 1.35-5.59, P=0.0053), and for vasopressors/inotropes (OR 2.68; CI 1.18-6.12, P=0.02); adequate empirical treatment had a protective effect (OR 0.48; CI 0.24-0.95, P=0.03).
CONCLUSION: TIMELY administration of adequately dosed treatment regimens and early ICU admission of critically ill patients could help in improving outcomes.