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
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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