Attributable mortality of ICU-acquired bloodstream infections: Impact of the source, causative micro-organism, resistance profile and antimicrobial therapy
Autor: | Christophe Adrie, Maité Garrouste-Orgeas, Wafa Ibn Essaied, Carole Schwebel, Michael Darmon, Bruno Mourvillier, Stéphane Ruckly, Anne-Sylvie Dumenil, Hatem Kallel, Laurent Argaud, Guillaume Marcotte, Francois Barbier, Virginie Laurent, Dany Goldgran-Toledano, Christophe Clec'h, Elie Azoulay, Bertrand Souweine, Jean-François Timsit, Yves Cohen, Maïté Garrouste-Orgeas, Lilia Soufir, Alban Le Monnier, Jean-Ralph Zahar, Corinne Alberti, Jean-Francois Timsit, Sebastien Bailly, Cecile Pommier, Wafa Ifn Essaeid, Aurélien Vannieuwenhuyze, Bernard Allaouchiche, Claire Ara-Somohano, Jean-Pierre Bedos, Agnès Bonadona, Anne-Laure Borel, Caroline Bornstain, Lila Bouadma, Alexandre Boyer, Jean-Pierre Colin, Antoine Gros, Rebecca Hamidfar-Roy, Hakim Haouache, Samir Jamali, Alexandre Lautrette, Christian Laplace, Benoit Misset, Laurent Montesino, Benoît Misset, Guillaume Lacave, Virgine Lemiale, Eric Marriotte, Benjamin Planquette, Jean Reignier, Romain Sonneville, Gilles Troché, Marie Thuong, Eric Vantalon, Caroline Tournegros, Loïc Ferrand, Nadira Kaddour, Boris Berthe, Kaouttar Mellouk, Sophie Letrou, Igor Théodose, Julien Fournier, Véronique Deiler |
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Přispěvatelé: | Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA) |
Rok vydání: | 2017 |
Předmět: |
Male
0301 basic medicine Databases Factual [SDV]Life Sciences [q-bio] Bacteremia Antimicrobial therapy law.invention antibiotic-therapy 0302 clinical medicine Risk Factors law Drug Resistance Multiple Bacterial 030212 general & internal medicine risk-factors Outcome Cross Infection pseudomonas-aeruginosa critically-ill patients Mortality rate Hazard ratio gram-negative bacteremia Middle Aged Antimicrobial Intensive care unit Anti-Bacterial Agents 3. Good health Intensive Care Units Treatment Outcome Infectious Diseases Female France Fluoroquinolones Microbiology (medical) medicine.medical_specialty Combination therapy 030106 microbiology Bloodstream infection 03 medical and health sciences Internal medicine medicine Humans intensive-care-unit matched cohort Intensive care medicine Aged combination Proportional hazards model business.industry organ dysfunction Pneumonia medicine.disease severe sepsis Multiple drug resistance Aminoglycosides septic shock Nosocomial business |
Zdroj: | Journal of Infection Journal of Infection, WB Saunders, 2017, 74 (2), pp.131-141. ⟨10.1016/j.jinf.2016.11.001⟩ |
ISSN: | 0163-4453 |
Popis: | International audience; Objectives: ICU-acquired bloodstream infection (ICU-BSI) in Intensive Care unit (ICU) is still associated with a high mortality rate. The increase of antimicrobial drug resistance makes its treatment increasingly challenging. Methods: We analyzed 571 ICU-BSI occurring amongst 10,734 patients who were prospectively included in the Outcomerea Database and who stayed at least 4 days in ICU. The hazard ratio of death associated with ICU-BSI was estimated using a multivariate Cox model adjusted on case mix, patient severity and daily SOFA. Results: ICU-BSI was associated with increased mortality (HR, 1.40; 95% CI, 1.16-1.69; p = 0.0004). The relative increase in the risk of death was 130% (HR, 2.3; 95% CI, 1.8-3.0) when initial antimicrobial agents within a day of ICU-BSI onset were not adequate, versus only 20% (HR, 1.2; 95% CI, 0.9-1.5) when an adequate therapy was started within a day. The adjusted hazard ratio of death was significant overall, and even higher when the ICU-BSI source was pneumonia or unknown origin. When treated with appropriate antimicrobial agents, the death risk increase was similar for ICU-BSI due to multidrug resistant pathogens or susceptible ones. Interestingly, combination therapy with a fluoroquinolone was associated with more favorable outcome than monotherapy, whereas combination with aminoglycoside was associated with similar mortality than monotherapy. Conclusions: ICU-BSI was associated with a 40% increase in the risk of 30-day mortality, particularly if the early antimicrobial therapy was not adequate. Adequacy of antimicrobial therapy, but not pathogen resistance pattern, impacted attributable mortality. (C) 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved. |
Databáze: | OpenAIRE |
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