Hospital-acquired bloodstream infections in critically ill cirrhotic patients: a post-hoc analysis of the EUROBACT-2 international cohort study.

Autor: Wozniak H; Division of Critical Care, Department of Acute Medicine, University Hospital of Geneva, University of Geneva, Geneva, Switzerland. Hannah.wozniak@hcuge.ch.; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada. Hannah.wozniak@hcuge.ch., Tabah A; Intensive Care Unit, Redcliffe Hospital, Brisbane, Australia.; Queensland Critical Care Research Network (QCCRN), Brisbane, QLD, Australia.; Queensland University of Technology, Brisbane, QLD, Australia.; Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia., Barbier F; Service de Médecine Intensive-Réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France., Ruckly S; Université de Paris, INSERM, IAME UMR 1137, Paris, 75018, France.; ICUREsearch, Biometry, Fontaine, 38600, France., Loiodice A; ICUREsearch, Biometry, Fontaine, 38600, France., Akova M; Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey., Leone M; Department of Anesthesiology and Intensive Care Unit, Hospital Nord, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France., Conway Morris A; Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.; Division of Immunology, Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, Cb2 1QP, UK.; JVF Intensive Care Unit, Addenbrooke's Hospital, Cambridge, Hills Road, Cambridge, CB2 0QQ, UK., Bassetti M; Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy., Arvaniti K; Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece., Ferrer R; Intensive Care Department, SODIR-VHIR Research Group, Vall d'Hebron University Hospital, Barcelona, Spain., de Bus L; Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium.; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium., Paiva JA; Intensive Care Medicine Department, Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal.; Department of Medicine, Faculty of Medicine, University of Porto (FMUP), Porto, Portugal., Bracht H; Central Interdisciplinary Emergency Medicine, University Hospital Ulm, Ulm, Germany., Mikstacki A; Faculty of Health Sciences, Poznan University of Medical Sciences, Poznan, Poland.; Department of Anaesthesiology and Intensive Therapy, Regional Hospital in Poznan, Poznan, Poland., Alsisi A; ICU Department, Prime Hospital, Dubai, United Arab Emirates.; Critical Care Department, Faculty of Medicine, Cairo University, Cairo, Egypt., Valeanu L; Cardiac Anesthesiology and Intensive Care Department I, Emergency Institute for Cardiovascular Diseases Prof. Dr. C. C. Iliescu, Bucharest, Romania., Prazak J; Department of Intensive Care Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland., Timsit JF; Université Paris- Cité, INSERM, IAME UMR 1137, Paris, 75018, France.; Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, Paris, France., Buetti N; Université Paris- Cité, INSERM, IAME UMR 1137, Paris, 75018, France.; Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, Faculty of Medicine, University Hospitals, University of Geneva, Geneva, Switzerland.
Jazyk: angličtina
Zdroj: Annals of intensive care [Ann Intensive Care] 2024 May 02; Vol. 14 (1), pp. 70. Date of Electronic Publication: 2024 May 02.
DOI: 10.1186/s13613-024-01299-x
Abstrakt: Background: Hospital-acquired bloodstream infections are common in the intensive care unit (ICU) and have a high mortality rate. Patients with cirrhosis are especially susceptible to infections, yet there is a knowledge gap in the epidemiological distinctions in hospital-acquired bloodstream infections between cirrhotic and non-cirrhotic patients in the ICU. It has been suggested that cirrhotic patients, present a trend towards more gram-positive infections, and especially enterococcal infections. This study aims to describe epidemiological differences in hospital-acquired bloodstream infections between cirrhotic and non-cirrhotic patients hospitalized in the ICU regarding infection sources, microorganisms and mortality.
Methods: Using prospective Eurobact-2 international cohort study data, we compared hospital-acquired bloodstream infections sources and microorganisms in cirrhotic and non-cirrhotic patients. The association between Enterococcus faecium and cirrhosis was studied using a multivariable mixed logistic regression. The association between cirrhosis and mortality was assessed by a multivariable frailty Cox model.
Results: Among the 1059 hospital-acquired bloodstream infections patients included from 101 centers, 160 had cirrhosis. Hospital-acquired bloodstream infection source in cirrhotic patients was primarily abdominal (35.6%), while it was pulmonary (18.9%) for non-cirrhotic (p < 0.01). Gram-positive hospital-acquired bloodstream infections accounted for 42.3% in cirrhotic patients compared to 33.2% in non-cirrhotic patients (p = 0.02). Hospital-acquired bloodstream infections in cirrhotic patients were most frequently caused by Klebsiella spp (16.5%), coagulase-negative Staphylococci (13.7%) and E. faecium (11.5%). E. faecium bacteremia was more frequent in cirrhotic patients (11.5% versus 4.5%, p < 0.01). After adjusting for possible confounding factors, cirrhosis was associated with higher E. faecium hospital-acquired bloodstream infections risk (Odds ratio 2.5, 95% CI 1.3-4.5, p < 0.01). Cirrhotic patients had increased mortality compared to non-cirrhotic patients (Hazard Ratio 1.3, 95% CI 1.01-1.7, p = 0.045).
Conclusions: Critically ill cirrhotic patients with hospital-acquired bloodstream infections exhibit distinct epidemiology, with more Gram-positive infections and particularly Enterococcus faecium.
(© 2024. The Author(s).)
Databáze: MEDLINE
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